Healthcare Provider Details

I. General information

NPI: 1063103430
Provider Name (Legal Business Name): FIDELITY NON EMERGENCY MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 FALL RIVER DR
COLUMBIA MO
65203
US

IV. Provider business mailing address

4508 FALL RIVER DR
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-825-8320
  • Fax:
Mailing address:
  • Phone: 573-825-8320
  • 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: NOE BIZIMANA RUSAYA
Title or Position: MANAGER
Credential:
Phone: 573-825-8320