Provider Demographics
NPI:1376025486
Name:PHOENIX TRANSPORT SERVICES LLC
Entity Type:Organization
Organization Name:PHOENIX TRANSPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-624-2476
Mailing Address - Street 1:3320 BUCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-5402
Mailing Address - Country:US
Mailing Address - Phone:321-339-6196
Mailing Address - Fax:
Practice Address - Street 1:3320 BUCKLAND ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-5402
Practice Address - Country:US
Practice Address - Phone:321-339-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)