Provider Demographics
NPI:1902044050
Name:MR. TAXI ,LLC
Entity Type:Organization
Organization Name:MR. TAXI ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALFONZO(TONY)
Authorized Official - Middle Name:E
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-687-1451
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:MS
Mailing Address - Zip Code:38879-1146
Mailing Address - Country:US
Mailing Address - Phone:662-810-7122
Mailing Address - Fax:662-810-7123
Practice Address - Street 1:5331 RAYMOND AVE.
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:MS
Practice Address - Zip Code:38879
Practice Address - Country:US
Practice Address - Phone:662-810-7122
Practice Address - Fax:662-810-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800540268343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)