Provider Demographics
NPI:1144606120
Name:FIDUS PARALOGISTICS
Entity Type:Organization
Organization Name:FIDUS PARALOGISTICS
Other - Org Name:GEMINI NEMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MADAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-870-6115
Mailing Address - Street 1:3613 NW 52ND TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6930
Mailing Address - Country:US
Mailing Address - Phone:352-870-6115
Mailing Address - Fax:180-098-5419
Practice Address - Street 1:3613 NW 52ND TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6930
Practice Address - Country:US
Practice Address - Phone:352-870-6115
Practice Address - Fax:180-098-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG14000088597343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)