=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316583677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYTA CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2019
-----------------------------------------------------
Last Update Date | 11/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 W OLNEY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19120-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-276-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 56581
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19111-6581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-276-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MR. TABEEL NOEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-893-0998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------