Provider Demographics
NPI:1164608915
Name:ODF MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:ODF MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:SHERIDAN
Authorized Official - Last Name:INSCO
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:469-223-0416
Mailing Address - Street 1:411 MERRITT ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3337
Mailing Address - Country:US
Mailing Address - Phone:469-223-0416
Mailing Address - Fax:
Practice Address - Street 1:411 MERRITT ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3337
Practice Address - Country:US
Practice Address - Phone:469-223-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000446341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB1018Medicare PIN