Provider Demographics
NPI:1073047452
Name:NORTHEAST TRANSPORTATION GROUP LLC.
Entity Type:Organization
Organization Name:NORTHEAST TRANSPORTATION GROUP LLC.
Other - Org Name:COASTAL CAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-246-9999
Mailing Address - Street 1:1840 MEALY ST S
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-1960
Mailing Address - Country:US
Mailing Address - Phone:904-246-9999
Mailing Address - Fax:904-685-6227
Practice Address - Street 1:1840 MEALY ST S
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-1960
Practice Address - Country:US
Practice Address - Phone:904-246-9999
Practice Address - Fax:904-685-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi