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General NPI Number Information
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NPI Number | 1851760714
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Entity Type | Organization
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Legal Business Name | MAKAK-2 LLC
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 403 DROSTE RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4879
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Country | US
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Telephone | 636-925-2022
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Fax | 636-925-1859
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Provider Business Mailing Address
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Address Line | 403 DROSTE RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4879
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Country | US
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Telephone | 636-925-2022
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Fax | 636-925-1859
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK ALLAN FINNEGAN
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Credential |
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Telephone | 636-925-2022
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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 | 22397361
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License Number State | MO
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