Provider Demographics
NPI:1700339199
Name:CASINO CAB CO LLC
Entity Type:Organization
Organization Name:CASINO CAB CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HAMMERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-322-4575
Mailing Address - Street 1:712 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-6190
Mailing Address - Country:US
Mailing Address - Phone:712-322-4575
Mailing Address - Fax:712-256-9033
Practice Address - Street 1:712 S 15TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-6190
Practice Address - Country:US
Practice Address - Phone:712-322-4575
Practice Address - Fax:712-256-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA512AG5373343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)