Provider Demographics
NPI:1629505565
Name:SOUL TAXI
Entity Type:Organization
Organization Name:SOUL TAXI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-592-1365
Mailing Address - Street 1:520 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3598
Mailing Address - Country:US
Mailing Address - Phone:435-592-1365
Mailing Address - Fax:
Practice Address - Street 1:520 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3598
Practice Address - Country:US
Practice Address - Phone:435-267-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10188114-0160343800000X, 343900000X
UT10188144-0160344600000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle