Provider Demographics
NPI:1194358622
Name:MIDWEST LIVERY LLC
Entity Type:Organization
Organization Name:MIDWEST LIVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUEIMNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:613-397-1800
Mailing Address - Street 1:929 NORMANDY TRACE RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5921
Mailing Address - Country:US
Mailing Address - Phone:613-397-1800
Mailing Address - Fax:
Practice Address - Street 1:2025 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2426
Practice Address - Country:US
Practice Address - Phone:614-530-4561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308621Medicaid