Provider Demographics
NPI:1043953680
Name:CANNON MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:CANNON MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:585-331-6060
Mailing Address - Street 1:12 CLINTWOOD DR APT A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-6525
Mailing Address - Country:US
Mailing Address - Phone:585-331-6060
Mailing Address - Fax:585-328-6226
Practice Address - Street 1:18748 ROCOCO RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-0100
Practice Address - Country:US
Practice Address - Phone:585-331-6060
Practice Address - Fax:585-331-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04284520Medicaid