Healthcare Provider Details

I. General information

NPI: 1194358622
Provider Name (Legal Business Name): MIDWEST LIVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S HIGH ST
COLUMBUS OH
43207-2426
US

IV. Provider business mailing address

929 NORMANDY TRACE RD
TAMPA FL
33602-5921
US

V. Phone/Fax

Practice location:
  • Phone: 614-530-4561
  • Fax:
Mailing address:
  • Phone: 613-397-1800
  • Fax:

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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: ADNAN MOUEIMNE
Title or Position: PRESIDENT
Credential:
Phone: 613-397-1800