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General NPI Number Information
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NPI Number | 1295288587
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Entity Type | Organization
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Legal Business Name | LEGACY MEDICAL TRANSPORTATION
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 4300 SEYMOUR ST
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City | DEARBORN
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State | MI
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Zip | 48126-2957
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Country | US
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Telephone | 313-615-0504
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 SEYMOUR ST
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City | DEARBORN
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State | MI
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Zip | 48126-2957
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FOIAD MOHAMED
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Credential |
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Telephone | 313-615-0504
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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 | L10938
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License Number State | MI
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