Provider Demographics
NPI:1962630707
Name:PROFESSIONAL SERVICE ENTERPRISE INC.
Entity Type:Organization
Organization Name:PROFESSIONAL SERVICE ENTERPRISE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-220-8499
Mailing Address - Street 1:PO BOX 9153
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-9153
Mailing Address - Country:US
Mailing Address - Phone:706-771-9101
Mailing Address - Fax:
Practice Address - Street 1:2623 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5939
Practice Address - Country:US
Practice Address - Phone:706-733-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)