Healthcare Provider Details

I. General information

NPI: 1689827339
Provider Name (Legal Business Name): MID-MISSOURI TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 CRAWFORD CIRCLE
SULLIVAN MO
63080-2514
US

IV. Provider business mailing address

634 CRAWFORD CIRCLE
SULLIVAN MO
63080-2514
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-8503
  • Fax: 576-468-7029
Mailing address:
  • Phone: 573-468-8503
  • Fax: 576-468-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTHA LYNN LINDSLEY
Title or Position: PRESIDENT
Credential:
Phone: 314-808-5983