1407632110 NPI number — AGNES TRANSPORTATION LIMITED LIABILITY COMPANY

Table of content: TERESA K. WOODFILL R.N. (NPI 1235246877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407632110 NPI number — AGNES TRANSPORTATION LIMITED LIABILITY COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGNES TRANSPORTATION LIMITED LIABILITY COMPANY
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:
1407632110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119-22 196TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11412-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-490-1563
Provider Business Mailing Address Fax Number:
866-466-3124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20031 LINDEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11412-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-490-1563
Provider Business Practice Location Address Fax Number:
866-466-3124
Provider Enumeration Date:
09/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BETHELMIE
Authorized Official First Name:
AGNES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-490-1563

Provider Taxonomy Codes

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

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





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