Healthcare Provider Details

I. General information

NPI: 1437963071
Provider Name (Legal Business Name): QUICKTRIP MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 CONNER ST STE 3214
DETROIT MI
48213-3498
US

IV. Provider business mailing address

5549 BLUEHILL ST
DETROIT MI
48224-2108
US

V. Phone/Fax

Practice location:
  • Phone: 865-378-9583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JAMIE PHILLIPS
Title or Position: C.E.O
Credential:
Phone: 865-378-9538