Provider Demographics
NPI:1053671057
Name:EAGLE TRANSPORT LLC
Entity Type:Organization
Organization Name:EAGLE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTISS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-266-6760
Mailing Address - Street 1:14360 SE 96TH CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-3616
Mailing Address - Country:US
Mailing Address - Phone:352-427-7723
Mailing Address - Fax:877-281-7652
Practice Address - Street 1:14360 SE 96TH CT
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-3616
Practice Address - Country:US
Practice Address - Phone:352-427-7723
Practice Address - Fax:877-281-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)