Healthcare Provider Details

I. General information

NPI: 1396006094
Provider Name (Legal Business Name): MISSTER CAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 W CENTRAL AVE
TOLEDO OH
43606-4048
US

IV. Provider business mailing address

1613 W CENTRAL AVE
TOLEDO OH
43606-4048
US

V. Phone/Fax

Practice location:
  • Phone: 419-472-6722
  • Fax:
Mailing address:
  • Phone: 419-472-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number48-178299
License Number StateOH

VIII. Authorized Official

Name: MARQUETTA ROBERTS
Title or Position: OWNER
Credential:
Phone: 419-472-6722