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General NPI Number Information
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NPI Number | 1972811743
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Entity Type | Organization
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Legal Business Name | ILLINOIS VALLEY CITY CAB, INC
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 206 3RD ST
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City | LA SALLE
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State | IL
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Zip | 61301-2385
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Country | US
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Telephone | 815-252-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 206 3RD ST
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City | LA SALLE
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State | IL
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Zip | 61301-2385
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Country | US
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Telephone |
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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. BRAD F SHOLDERS
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Credential |
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Telephone | 815-252-5513
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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 |
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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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