1689913154 NPI number — FARE WAY TRANSPORTATION

Table of content: (NPI 1689913154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689913154 NPI number — FARE WAY TRANSPORTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARE WAY TRANSPORTATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689913154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 E VAN FLEET DR STE 245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTOW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33830-3829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-581-0881
Provider Business Mailing Address Fax Number:
863-500-1976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 GOLFVIEW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33801-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-581-0881
Provider Business Practice Location Address Fax Number:
863-500-1976
Provider Enumeration Date:
02/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
VENTURA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
863-271-4398

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114599900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com