Provider Demographics
NPI:1164016465
Name:MAXX TRANSIT LLC
Entity Type:Organization
Organization Name:MAXX TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-405-9339
Mailing Address - Street 1:24555 SOUTHFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2738
Mailing Address - Country:US
Mailing Address - Phone:313-405-9336
Mailing Address - Fax:
Practice Address - Street 1:24555 SOUTHFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2738
Practice Address - Country:US
Practice Address - Phone:313-405-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9492026Medicaid