Healthcare Provider Details

I. General information

NPI: 1508124454
Provider Name (Legal Business Name): OWNERS ON CALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 04/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 NICOLET PL
DETROIT MI
48207-2838
US

IV. Provider business mailing address

1344 NICOLET PL
DETROIT MI
48207-2838
US

V. Phone/Fax

Practice location:
  • Phone: 248-979-1464
  • Fax:
Mailing address:
  • Phone: 248-979-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLIE BOTHUELL IV
Title or Position: CEO
Credential:
Phone: 248-979-1464