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General NPI Number Information
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NPI Number | 1700339199
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Entity Type | Organization
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Legal Business Name | CASINO CAB CO LLC
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 712 S 15TH ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-6190
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Country | US
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Telephone | 712-322-4575
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Fax | 712-256-9033
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Provider Business Mailing Address
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Address Line | 712 S 15TH ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-6190
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Country | US
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Telephone | 712-322-4575
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Fax | 712-256-9033
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Authorized Official
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Title or Position | OWNER
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Name | JOHN THOMAS HAMMERL
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Credential |
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Telephone | 712-322-4575
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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 | 512AG5373
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License Number State | IA
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