=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902404064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG RALPHS TAXI SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2020
-----------------------------------------------------
Last Update Date | 10/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 754 STATE HIGHWAY 7 LOT 14
-----------------------------------------------------
City | UNADILLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13849-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-624-6932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 754 STATE HIGHWAY 7 LOT 14
-----------------------------------------------------
City | UNADILLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13849-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-624-6932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER
-----------------------------------------------------
Name | CORYN ROCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-624-6932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------