Provider Demographics
NPI:1932760329
Name:PLATINUM FOX NONEMERGENCY MEDICAL TRANSPORT LLC.
Entity Type:Organization
Organization Name:PLATINUM FOX NONEMERGENCY MEDICAL TRANSPORT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER/DRIVER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEIQUELA
Authorized Official - Middle Name:LATICE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-532-6539
Mailing Address - Street 1:4940 THRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2224
Mailing Address - Country:US
Mailing Address - Phone:314-532-6539
Mailing Address - Fax:
Practice Address - Street 1:4940 THRUSH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-2224
Practice Address - Country:US
Practice Address - Phone:314-532-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)