Provider Demographics
NPI:1194460931
Name:BERNICE COLEMAN
Entity Type:Organization
Organization Name:BERNICE COLEMAN
Other - Org Name:BERNICE COLEMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-880-7217
Mailing Address - Street 1:405 ISAAC CIR APT D
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-9036
Mailing Address - Country:US
Mailing Address - Phone:972-880-7217
Mailing Address - Fax:
Practice Address - Street 1:405 ISAAC CIR APT D
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-9036
Practice Address - Country:US
Practice Address - Phone:972-880-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR33676977OtherDRIVER LICENSE