Provider Demographics
NPI:1952168486
Name:MEDIVELO LOGISTICS LLC
Entity Type:Organization
Organization Name:MEDIVELO LOGISTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:O
Authorized Official - Last Name:BWAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-630-0243
Mailing Address - Street 1:10366 TAYLOR RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7620
Mailing Address - Country:US
Mailing Address - Phone:901-630-0243
Mailing Address - Fax:
Practice Address - Street 1:10366 TAYLOR RIDGE CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-7620
Practice Address - Country:US
Practice Address - Phone:901-630-0243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty