=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780112938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POINT TO POINT TRANSPORTATION,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2017
-----------------------------------------------------
Last Update Date | 05/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2403 BRANTWOOD BLVD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45404-1595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-838-4813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2403 BRANTWOOD BLVD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45404-1595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-838-0011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENYATTA M ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-259-8012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | RN746364
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------