Provider Demographics
NPI:1598237398
Name:PICCADILLY TRANSPORT LC
Entity Type:Organization
Organization Name:PICCADILLY TRANSPORT LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NWACHUKWU
Authorized Official - Middle Name:J
Authorized Official - Last Name:EKEOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-386-5476
Mailing Address - Street 1:270 TRACE COLONY PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8810
Mailing Address - Country:US
Mailing Address - Phone:469-386-5476
Mailing Address - Fax:
Practice Address - Street 1:270 TRACE COLONY PARK DR STE B
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8810
Practice Address - Country:US
Practice Address - Phone:469-386-5476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)