Provider Demographics
NPI:1528621695
Name:NICHOLAS ONEAL TRANSPORT
Entity type:Organization
Organization Name:NICHOLAS ONEAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-767-2417
Mailing Address - Street 1:1511 DREAMA DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6615
Mailing Address - Country:US
Mailing Address - Phone:469-767-2417
Mailing Address - Fax:
Practice Address - Street 1:3225 EMERALD LN STE A
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6869
Practice Address - Country:US
Practice Address - Phone:469-767-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)