Provider Demographics
NPI:1134676208
Name:FRIENDSHIP MB CHURCH TRANSPORTATION
Entity type:Organization
Organization Name:FRIENDSHIP MB CHURCH TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-736-5460
Mailing Address - Street 1:141 FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429
Mailing Address - Country:US
Mailing Address - Phone:601-736-5460
Mailing Address - Fax:601-736-5831
Practice Address - Street 1:141 FRIENDSHIP CHURCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-736-5460
Practice Address - Fax:601-736-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2016064434343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)