Provider Demographics
NPI:1811309503
Name:BWB REASONABLE AND RELIABLE TRANSPORTATION
Entity type:Organization
Organization Name:BWB REASONABLE AND RELIABLE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-695-0808
Mailing Address - Street 1:PO BOX 980275
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-0275
Mailing Address - Country:US
Mailing Address - Phone:734-695-0808
Mailing Address - Fax:
Practice Address - Street 1:512 WASHTENAW RD APT 18
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-695-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC514139402772343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1811309503Medicaid
MI343900000XMedicaid
MI1811309503OtherBLUE CROSS AND BLUE SHIELD
MI1811309503Medicare Oscar/Certification
MI1811309503OtherBLUE CROSS AND BLUE SHIELD
MI1811309503Medicaid
MI1811309503Medicare PIN