1881048155 NPI number — P NICHOLAS ENTERPRISES LLC

Table of content: (NPI 1881048155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881048155 NPI number — P NICHOLAS ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P NICHOLAS ENTERPRISES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GO MEDICAL TRANSPORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881048155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2327 COLFLESH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERKIOMENVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18074-9526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-960-0142
Provider Business Mailing Address Fax Number:
610-754-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 LINFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-960-0142
Provider Business Practice Location Address Fax Number:
610-754-9266
Provider Enumeration Date:
04/22/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOBSON
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-960-0142

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)