=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790953834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITA LOUISE PALMER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2008
-----------------------------------------------------
Last Update Date | 07/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8210 COYLE ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48228-2451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-605-0555
-----------------------------------------------------
Fax | 313-846-6889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4128
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48204-0128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-605-0555
-----------------------------------------------------
Fax | 313-846-6889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. RITA LOUISE PALMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-605-0555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | P456738549356
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------