Provider Demographics
NPI:1699376939
Name:SUPREME TAXI LLC
Entity Type:Organization
Organization Name:SUPREME TAXI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBANJI
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:804-501-9442
Mailing Address - Street 1:5407 GRIST MILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6705
Mailing Address - Country:US
Mailing Address - Phone:804-501-9442
Mailing Address - Fax:
Practice Address - Street 1:5407 GRIST MILL DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6705
Practice Address - Country:US
Practice Address - Phone:804-501-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)