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General NPI Number Information
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NPI Number | 1073737474
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Entity Type | Organization
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Legal Business Name | CLASSIC TAXI
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 526 SIEBERT DR
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2296
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Country | US
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Telephone | 219-322-8758
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Fax | 219-322-8908
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Provider Business Mailing Address
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Address Line | 526 SIEBERT DR
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2296
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Country | US
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Telephone | 219-322-8758
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Fax | 219-322-8908
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KENNETH R STEVENSON
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Credential |
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Telephone | 219-322-8758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | 0114313741 001
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License Number State | IN
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