=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740675941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR RCD TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2015
-----------------------------------------------------
Last Update Date | 04/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4351 DELMAR BLVD STE C
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-932-7301
-----------------------------------------------------
Fax | 314-289-9456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4351 DELMAR BLVD STE C
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-932-7301
-----------------------------------------------------
Fax | 314-289-9456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DWIGHT DICKINSON SR.
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 314-952-9530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | M208259031
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------