Provider Demographics
NPI:1629774336
Name:MR. EARLY BIRD LOGISTICS LLC
Entity Type:Organization
Organization Name:MR. EARLY BIRD LOGISTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-888-0151
Mailing Address - Street 1:500 S FLORIDA AVE SUITE 415 PMB 1031
Mailing Address - Street 2:SUITE 415 PMB 1031
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801
Mailing Address - Country:US
Mailing Address - Phone:863-888-0151
Mailing Address - Fax:
Practice Address - Street 1:500 S FLORIDA AVE
Practice Address - Street 2:SUITE 415 PMB 1031
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:863-888-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MR. TERIS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)