Provider Demographics
NPI:1417797119
Name:PANOLIA MEDIFLEET LLC
Entity type:Organization
Organization Name:PANOLIA MEDIFLEET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENAYI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIACHAKANZWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-615-9583
Mailing Address - Street 1:3626 N HALL ST STE 610
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5131
Mailing Address - Country:US
Mailing Address - Phone:682-399-7053
Mailing Address - Fax:
Practice Address - Street 1:3626 N HALL ST STE 610
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5131
Practice Address - Country:US
Practice Address - Phone:682-399-7053
Practice Address - Fax:682-399-7053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle