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General NPI Number Information
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NPI Number | 1427453604
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Entity Type | Organization
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Legal Business Name | MONTYS TRANNSPORTATION, LLC
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 27200 PARKVIEW BLVD SUITE #208
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City | WARREN
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State | MI
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Zip | 48092-2884
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Country | US
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Telephone | 313-980-1241
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Fax | 586-806-6437
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Provider Business Mailing Address
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Address Line | PO BOX 141002
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City | DETROIT
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State | MI
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Zip | 48214-5002
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Country | US
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Telephone | 313-980-1241
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Fax | 586-806-6437
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Authorized Official
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Title or Position | OWNER/DRIVER
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Name | MR. GARY MONTGOMERY
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Credential |
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Telephone | 313-980-1241
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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 | 2446
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License Number State | MI
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