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General NPI Number Information
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NPI Number | 1295126837
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Entity Type | Organization
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Legal Business Name | DECATUR CITY TAXI & DELIVERY INC
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 411 E WILLIAM ST
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City | DECATUR
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State | IL
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Zip | 62523-1140
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Country | US
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Telephone | 217-330-7960
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Fax |
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Provider Business Mailing Address
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Address Line | 411 E WILLIAM ST
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City | DECATUR
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State | IL
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Zip | 62523-1140
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Country | US
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Telephone | 217-330-7960
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MICHAEL SCOTT BOLIARD
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Credential |
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Telephone | 217-330-7960
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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 |
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Taxonomy #2
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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