Provider Demographics
NPI:1326485061
Name:MAXIAN INDUSTRIES INC
Entity Type:Organization
Organization Name:MAXIAN INDUSTRIES INC
Other - Org Name:CHOICE TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WASHINGTON HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-262-6060
Mailing Address - Street 1:1737 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1501
Mailing Address - Country:US
Mailing Address - Phone:334-262-6060
Mailing Address - Fax:334-262-0091
Practice Address - Street 1:1737 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1501
Practice Address - Country:US
Practice Address - Phone:334-262-6060
Practice Address - Fax:334-262-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5289343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL146Medicaid