Healthcare Provider Details

I. General information

NPI: 1336557636
Provider Name (Legal Business Name): PREMIUM TRANSPORTATION ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18625 MUIRLAND ST
DETROIT MI
48221-2202
US

IV. Provider business mailing address

3319 GREENFIELD RD #172
DEARBORN MI
48120-1212
US

V. Phone/Fax

Practice location:
  • Phone: 888-657-0467
  • Fax: 313-429-0283
Mailing address:
  • Phone: 888-657-0467
  • Fax: 313-429-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KEVIN WILLIAMS
Title or Position: OWNER
Credential:
Phone: 313-633-5811