Healthcare Provider Details

I. General information

NPI: 1932548781
Provider Name (Legal Business Name): LEVEL ONE TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E FORT ST STE 103
DETROIT MI
48226-2959
US

IV. Provider business mailing address

407 E FORT ST STE 103
DETROIT MI
48226-2959
US

V. Phone/Fax

Practice location:
  • Phone: 313-421-2624
  • Fax:
Mailing address:
  • Phone: 313-421-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMI

VIII. Authorized Official

Name: LISA C TUCKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 313-421-2624