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General NPI Number Information
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NPI Number | 1164608915
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Entity Type | Organization
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Legal Business Name | ODF MEDICAL TRANSPORT
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 411 MERRITT ST
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-3337
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Country | US
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Telephone | 469-223-0416
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Fax |
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Provider Business Mailing Address
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Address Line | 411 MERRITT ST
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-3337
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Country | US
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Telephone | 469-223-0416
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILIP SHERIDAN INSCO II
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Credential |
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Telephone | 469-223-0416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1000446
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License Number State | TX
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