Healthcare Provider Details

I. General information

NPI: 1013227834
Provider Name (Legal Business Name): ROUTE 66 CAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 E US HIGHWAY 66
KINGMAN AZ
86409
US

IV. Provider business mailing address

3595 E US HIGHWAY 66
KINGMAN AZ
86409
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-6600
  • Fax: 877-774-3392
Mailing address:
  • Phone: 928-681-6600
  • Fax: 877-774-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number09-6258
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number94-6258
License Number StateAZ

VIII. Authorized Official

Name: ANTHONY HEATLEY
Title or Position: MANAGER
Credential:
Phone: 928-303-7314