Healthcare Provider Details

I. General information

NPI: 1366934135
Provider Name (Legal Business Name): LATENITE DISPATCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8560 CODY CT
HUBER HEIGHTS OH
45424-1245
US

IV. Provider business mailing address

5705 ROSEMONT CT
INDIANAPOLIS IN
46254-5027
US

V. Phone/Fax

Practice location:
  • Phone: 937-829-7341
  • Fax:
Mailing address:
  • Phone: 317-215-1714
  • 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 Code347E00000X
TaxonomyTransportation Broker
License NumberHHC9818
License Number StateOH

VIII. Authorized Official

Name: MS. LORETTA FLOYD
Title or Position: MANAGING PARTNER
Credential:
Phone: 937-829-7341