Healthcare Provider Details

I. General information

NPI: 1982584090
Provider Name (Legal Business Name): AMVIC 360 TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 EXECUTIVE PKWY APT 518
WESTERVILLE OH
43081-3876
US

IV. Provider business mailing address

4252 EXECUTIVE PKWY APT 518
WESTERVILLE OH
43081-3876
US

V. Phone/Fax

Practice location:
  • Phone: 949-732-8937
  • Fax:
Mailing address:
  • Phone: 949-732-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: KOFI ODURO
Title or Position: DIRECTOR
Credential: MD
Phone: 949-732-8937