Provider Demographics
NPI:1114602141
Name:BOLI AND SON EXPRESS LLC
Entity Type:Organization
Organization Name:BOLI AND SON EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:EBONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-880-7542
Mailing Address - Street 1:908 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8208
Mailing Address - Country:US
Mailing Address - Phone:972-880-7542
Mailing Address - Fax:
Practice Address - Street 1:908 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8208
Practice Address - Country:US
Practice Address - Phone:972-880-7542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERIDIAN MMA COMMUTE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)