Provider Demographics
NPI:1336557636
Name:PREMIUM TRANSPORTATION ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PREMIUM TRANSPORTATION ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-633-5811
Mailing Address - Street 1:3319 GREENFIELD RD
Mailing Address - Street 2:#172
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1212
Mailing Address - Country:US
Mailing Address - Phone:888-657-0467
Mailing Address - Fax:313-429-0283
Practice Address - Street 1:18625 MUIRLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2202
Practice Address - Country:US
Practice Address - Phone:888-657-0467
Practice Address - Fax:313-429-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)