Provider Demographics
NPI:1255322236
Name:MEDEVAC, LLC
Entity Type:Organization
Organization Name:MEDEVAC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:III
Authorized Official - Credentials:MBA, RRT, EMT
Authorized Official - Phone:813-633-3822
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:MANGO
Mailing Address - State:FL
Mailing Address - Zip Code:33550-0654
Mailing Address - Country:US
Mailing Address - Phone:813-633-3822
Mailing Address - Fax:
Practice Address - Street 1:424 DOWN PINE DRIVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3719
Practice Address - Country:US
Practice Address - Phone:813-633-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BX2000X, 341600000X, 3416A0800X, 3416L0300X, 343900000X
333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC46Y26OtherFEDERAL CONTRACTOR CAGE CODE