=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639327950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON TIME MEDICAL TRANSPORTATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2008
-----------------------------------------------------
Last Update Date | 08/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 WOODWARD AVE SUITE 1057
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48226-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-567-4945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1411 E JEFFERSON AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48207-3156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HORATIO WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-567-4945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | L-0991
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------