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General NPI Number Information
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NPI Number | 1669730701
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Entity Type | Organization
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Legal Business Name | ROUND TRIP SERVICE LLC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 47758 HICKORY ST 22208
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City | WIXOM
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State | MI
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Zip | 48393-2719
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Country | US
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Telephone | 734-512-6165
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Fax | 248-246-0773
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Provider Business Mailing Address
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Address Line | 47758 HICKORY ST 22208
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City | WIXOM
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State | MI
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Zip | 48393-2719
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Country | US
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Telephone | 734-512-6165
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Fax | 248-246-0773
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Authorized Official
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Title or Position | MANAGER
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Name | MR. TREMELL MCCASKILL
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Credential |
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Telephone | 734-512-6165
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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 | D73449
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License Number State | MI
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