=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487052684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T & I TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2014
-----------------------------------------------------
Last Update Date | 12/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26250 RONALD ST
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48066-4459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-362-0823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 377
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48066-0377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-362-0823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MS. TIMEKA L. HAIRSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-859-7479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | H623793488249
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------