Provider Demographics
NPI:1932861689
Name:WHITE, CYRIL BRUCE II
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:BRUCE
Last Name:WHITE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 COVINGTON CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3564
Mailing Address - Country:US
Mailing Address - Phone:630-768-2454
Mailing Address - Fax:
Practice Address - Street 1:1663 COVINGTON CT
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3564
Practice Address - Country:US
Practice Address - Phone:630-768-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)