Healthcare Provider Details

I. General information

NPI: 1306477161
Provider Name (Legal Business Name): PUTNAM TAXI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SCHOOL ST APT 6
PUTNAM CT
06260-1630
US

IV. Provider business mailing address

PO BOX 600
PUTNAM CT
06260-0600
US

V. Phone/Fax

Practice location:
  • Phone: 860-336-9151
  • Fax:
Mailing address:
  • Phone: 860-336-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WINFIELD FREEMAN
Title or Position: OWNER
Credential:
Phone: 860-928-7433