Healthcare Provider Details

I. General information

NPI: 1497464093
Provider Name (Legal Business Name): BLDZ ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N 8TH ST STE 10224
KILLEEN TX
76541-5215
US

IV. Provider business mailing address

402 N 8TH ST STE 10224
KILLEEN TX
76541-5215
US

V. Phone/Fax

Practice location:
  • Phone: 254-232-4221
  • Fax:
Mailing address:
  • Phone: 254-232-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LAKISHA LITTLE
Title or Position: PRESIDENT
Credential:
Phone: 254-232-4122