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General NPI Number Information
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NPI Number | 1821568635
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Entity Type | Organization
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Legal Business Name | GRAY WOLF TRANSPORTATION LLC
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 115 AVONDALE DR
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City | DAYTON
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State | OH
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Zip | 45404-2123
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Country | US
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Telephone | 888-415-9644
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Fax | 888-415-0950
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Provider Business Mailing Address
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Address Line | 303 DEEDS AVE
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City | DAYTON
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State | OH
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Zip | 45404-1719
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Country | US
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Telephone | 937-396-4847
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Fax | 888-415-0950
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MIRZA MIRZA
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Credential |
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Telephone | 937-396-4847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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