Provider Demographics
NPI:1235995549
Name:MISSION POSSIBLE TRANSPORT, INC
Entity Type:Organization
Organization Name:MISSION POSSIBLE TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MIDDLEBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-508-0223
Mailing Address - Street 1:1200 RIVERPLACE BLVD STE 1051001
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9046
Mailing Address - Country:US
Mailing Address - Phone:850-508-0223
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVERPLACE BLVD STE 1051001
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9046
Practice Address - Country:US
Practice Address - Phone:850-508-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)