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General NPI Number Information
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NPI Number | 1679370936
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Entity Type | Organization
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Legal Business Name | ANGEL WINGS MEDICAL TRANSIT LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 511 N INGRAM RD
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City | SIKESTON
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State | MO
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Zip | 63801-5101
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Country | US
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Telephone | 573-838-3168
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Fax |
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Provider Business Mailing Address
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Address Line | 511 N INGRAM RD
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City | SIKESTON
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State | MO
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Zip | 63801
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Country | US
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Telephone | 877-296-8552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DERICK L NEWSON SR.
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Credential |
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Telephone | 877-296-8552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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