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General NPI Number Information
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NPI Number | 1962148114
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Entity Type | Organization
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Legal Business Name | MODICAN MEDICAL & SAFETY TRAINING INC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 5331 SW 116TH PL
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City | OCALA
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State | FL
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Zip | 34476-4456
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Country | US
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Telephone | 248-820-1712
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Fax |
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Provider Business Mailing Address
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Address Line | 909 E MAPLE ST
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City | HOLLY
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State | MI
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Zip | 48442-1755
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Country | US
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Telephone | 248-820-1712
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | OLIVIA PASS
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Credential |
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Telephone | 248-820-1712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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