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General NPI Number Information
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NPI Number | 1295270502
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Entity Type | Organization
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Legal Business Name | PANTHER VENTURES LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 1050 SHEFFIELD AVE STE C
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City | WATERLOO
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State | IA
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Zip | 50702-2036
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Country | US
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Telephone | 319-239-7334
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 FALLS AVENUE
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City | WATERLOO
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State | IA
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Zip | 50701
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Country | US
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Telephone | 319-252-4857
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Fax | 319-252-4858
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. ROSE ANN MILLER
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Credential |
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Telephone | 319-239-7334
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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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