Provider Demographics
NPI:1912419987
Name:OMNICARE TRANSPORT LLC
Entity Type:Organization
Organization Name:OMNICARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MWANA
Authorized Official - Middle Name:NDOMBE
Authorized Official - Last Name:IFULU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-834-1507
Mailing Address - Street 1:1137 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2570
Mailing Address - Country:US
Mailing Address - Phone:972-834-1507
Mailing Address - Fax:972-590-2192
Practice Address - Street 1:1137 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2570
Practice Address - Country:US
Practice Address - Phone:972-834-1507
Practice Address - Fax:972-590-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)