Healthcare Provider Details

I. General information

NPI: 1023442829
Provider Name (Legal Business Name): AMERICAN SHUTTLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6353 S SAGINAW RD
GRAND BLANC MI
48439-8140
US

IV. Provider business mailing address

6353 S SAGINAW RD
GRAND BLANC MI
48439-8140
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-5003
  • Fax: 810-503-4450
Mailing address:
  • Phone: 810-694-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License NumberL3122
License Number StateMI

VIII. Authorized Official

Name: GERALD MICHAEL ODGLEN
Title or Position: CEO
Credential:
Phone: 810-694-5003