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General NPI Number Information
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NPI Number | 1740454370
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Entity Type | Organization
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Legal Business Name | TELECAB, INC.
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 302 PRAIRIE AVE
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City | LOCKPORT
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State | IL
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Zip | 60441-4433
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Country | US
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Telephone | 815-726-8294
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Fax | 815-726-3080
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Provider Business Mailing Address
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Address Line | PO BOX 3999
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City | JOLIET
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State | IL
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Zip | 60434-3999
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Country | US
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Telephone | 815-726-8294
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Fax | 815-726-3080
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MRS. KIMBERLY DAWN ANDERSON
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Credential |
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Telephone | 815-726-8294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | 8305TX
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License Number State | IL
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