Healthcare Provider Details

I. General information

NPI: 1164003729
Provider Name (Legal Business Name): CITY CAB LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 PENNELWOOD DR
TOLEDO OH
43614-2657
US

IV. Provider business mailing address

1521 PENNELWOOD DR
TOLEDO OH
43614-2657
US

V. Phone/Fax

Practice location:
  • Phone: 419-283-1651
  • Fax:
Mailing address:
  • Phone: 419-283-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BENNIE JOHNSON III
Title or Position: OWNER
Credential:
Phone: 419-283-1651