=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205345683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUTTLE BUG TAXI INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2017
-----------------------------------------------------
Last Update Date | 09/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 WEMPLE RD
-----------------------------------------------------
City | GLENMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12077-3532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-928-9976
-----------------------------------------------------
Fax | 518-928-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 WEMPLE RD
-----------------------------------------------------
City | GLENMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12077-3532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-928-9976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. TIMOTHY CUTTLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-928-9976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------