Provider Demographics
NPI:1114589579
Name:NORTH FLORIDA SHUTTLE CORP
Entity Type:Organization
Organization Name:NORTH FLORIDA SHUTTLE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:904-860-8284
Mailing Address - Street 1:10235 CHASON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8677
Mailing Address - Country:US
Mailing Address - Phone:904-860-8284
Mailing Address - Fax:904-862-6772
Practice Address - Street 1:10235 CHASON LAKES DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8677
Practice Address - Country:US
Practice Address - Phone:904-860-8284
Practice Address - Fax:904-862-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)