Healthcare Provider Details

I. General information

NPI: 1053830554
Provider Name (Legal Business Name): COEBURN TAXI SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 CANEY RIDGE RD
COEBURN VA
24230-5122
US

IV. Provider business mailing address

PO BOX 2357
COEBURN VA
24230-2357
US

V. Phone/Fax

Practice location:
  • Phone: 276-395-2536
  • Fax: 276-395-2976
Mailing address:
  • Phone: 276-395-2536
  • Fax: 276-395-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEE RING
Title or Position: PRESIDENT
Credential:
Phone: 276-395-2536