Provider Demographics
NPI:1598162364
Name:BACK TO FRONT PIZZA LLC
Entity Type:Organization
Organization Name:BACK TO FRONT PIZZA LLC
Other - Org Name:UNIVERSAL MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-861-7660
Mailing Address - Street 1:540 ROCK PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-6562
Mailing Address - Country:US
Mailing Address - Phone:817-862-7660
Mailing Address - Fax:817-349-0036
Practice Address - Street 1:540 ROCK PRAIRIE LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-6562
Practice Address - Country:US
Practice Address - Phone:817-862-7660
Practice Address - Fax:817-349-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)