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General NPI Number Information
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NPI Number | 1114154978
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Entity Type | Organization
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Legal Business Name | GREATER LAKES TRANSPORTATION
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 53 1/2 W HURON ST SUITE #221
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City | PONTIAC
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State | MI
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Zip | 48342-2121
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Country | US
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Telephone | 248-456-0738
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Fax | 248-456-0739
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Provider Business Mailing Address
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Address Line | 53 1/2 W HURON ST SUITE #221
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City | PONTIAC
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State | MI
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Zip | 48342-2121
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Country | US
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Telephone | 248-456-0738
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Fax | 248-456-0739
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. REGINALD J. WATKINS
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Credential |
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Telephone | 248-456-0738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | MI
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