Provider Demographics
NPI:1144565250
Name:SPECIALIZED PATIENT TRANSPORT LLC
Entity Type:Organization
Organization Name:SPECIALIZED PATIENT TRANSPORT LLC
Other - Org Name:MEDEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-215-3770
Mailing Address - Street 1:2511 MARLIN CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6644
Mailing Address - Country:US
Mailing Address - Phone:904-215-3770
Mailing Address - Fax:904-215-4414
Practice Address - Street 1:2511 MARLIN CT
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6644
Practice Address - Country:US
Practice Address - Phone:904-215-3770
Practice Address - Fax:904-215-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)