Healthcare Provider Details

I. General information

NPI: 1164116182
Provider Name (Legal Business Name): REQUEST NON EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50480 BAY RUN N
CHESTERFIELD MI
48047-4686
US

IV. Provider business mailing address

155 S MAIN ST UNIT 82
MOUNT CLEMENS MI
48046-7704
US

V. Phone/Fax

Practice location:
  • Phone: 810-309-9727
  • Fax:
Mailing address:
  • Phone: 810-309-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: SEAN L POWELL
Title or Position: OWNER
Credential:
Phone: 586-234-9050