Healthcare Provider Details

I. General information

NPI: 1104601400
Provider Name (Legal Business Name): IDOKO TIMELY TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 09/23/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CAMPUS BLVD SUITE 100
NEWTOWN SQUARE PA
19073
US

IV. Provider business mailing address

P.O. BOX 4916
HARRISBURG PA
17111
US

V. Phone/Fax

Practice location:
  • Phone: 717-339-7728
  • Fax:
Mailing address:
  • Phone: 516-666-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNEY C IDOKO
Title or Position: MANAGER
Credential:
Phone: 516-666-1758