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General NPI Number Information
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NPI Number | 1811309503
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Entity Type | Organization
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Legal Business Name | BWB REASONABLE AND RELIABLE TRANSPORTATION
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 512 WASHTENAW RD APT 18
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City | YPSILANTI
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State | MI
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Zip | 48197
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Country | US
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Telephone | 734-695-0808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 980275
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City | YPSILANTI
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State | MI
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Zip | 48198-0275
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Country | US
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Telephone | 734-695-0808
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DERRICK CAMPBELL
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Credential |
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Telephone | 734-695-0808
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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 | C514139402772
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License Number State | MI
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