Provider Demographics
NPI:1750741948
Name:MAXWELL'S TRANSIT SERVICE
Entity type:Organization
Organization Name:MAXWELL'S TRANSIT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VIDAL
Authorized Official - Middle Name:MASHUN
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:662-617-9866
Mailing Address - Street 1:2541 HIGHWAY 182 W
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9455
Mailing Address - Country:US
Mailing Address - Phone:662-617-9866
Mailing Address - Fax:
Practice Address - Street 1:2541 HIGHWAY 182 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9455
Practice Address - Country:US
Practice Address - Phone:662-617-9866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801593435347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS801593435OtherDRIVERS LICENSE