Provider Demographics
NPI:1437352762
Name:SAFEWAY TAXI
Entity Type:Organization
Organization Name:SAFEWAY TAXI
Other - Org Name:SAFEWAY TRANSPORTATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WAMPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-662-2555
Mailing Address - Street 1:1729 W NELSON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3323
Mailing Address - Country:US
Mailing Address - Phone:765-662-2555
Mailing Address - Fax:
Practice Address - Street 1:1729 W NELSON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3323
Practice Address - Country:US
Practice Address - Phone:765-662-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1099263344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132060AOtherPROVIDER ID
IN200132060Medicaid