Healthcare Provider Details

I. General information

NPI: 1275895781
Provider Name (Legal Business Name): BOULEVARD TAXI EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 GRIER ST
SUMTER SC
29150-4333
US

IV. Provider business mailing address

35 GRIER ST
SUMTER SC
29150-4333
US

V. Phone/Fax

Practice location:
  • Phone: 803-983-0381
  • Fax:
Mailing address:
  • Phone: 803-983-0381
  • Fax: 803-775-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number008586304
License Number StateSC

VIII. Authorized Official

Name: MR. ERIC TRACY DAVIS
Title or Position: OWNER
Credential:
Phone: 803-983-0381