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General NPI Number Information
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NPI Number | 1871929406
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Entity Type | Organization
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Legal Business Name | RED TIRE CAB LLC
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Dates
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Enumeration Date | 09/14/2013
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Last Update Date | 09/14/2013
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Provider Practice Location Address
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Address Line | 615 N FAIRVIEW ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3775
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Country | US
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Telephone | 812-391-7344
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5006
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City | BLOOMINGTON
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State | IN
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Zip | 47407-5006
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Country | US
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Telephone | 812-391-7344
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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. HESHAM GENIDY
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Credential |
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Telephone | 812-391-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State | IN
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