Provider Demographics
NPI:1033690078
Name:LGC MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:LGC MEDICAL TRANSPORTATION
Other - Org Name:LGC MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GERONIMO
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:ENGINEER OWNER
Authorized Official - Phone:813-528-3692
Mailing Address - Street 1:6719 GALL BLVD STE 201C
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2569
Mailing Address - Country:US
Mailing Address - Phone:813-528-3692
Mailing Address - Fax:
Practice Address - Street 1:6719 GALL BLVD STE 201C
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2569
Practice Address - Country:US
Practice Address - Phone:813-528-3692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)