Provider Demographics
NPI:1588056444
Name:PROFESSIONAL AND CONVENIENT NON EMERGENCY TRANSPORTATION
Entity type:Organization
Organization Name:PROFESSIONAL AND CONVENIENT NON EMERGENCY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:574-849-2746
Mailing Address - Street 1:3604 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-4494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3604 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4494
Practice Address - Country:US
Practice Address - Phone:574-849-2746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN428071343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)