Provider Demographics
NPI:1376816835
Name:EDMT CORPORATION
Entity Type:Organization
Organization Name:EDMT CORPORATION
Other - Org Name:EDMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:A153-210-72-132-0
Authorized Official - Phone:954-670-9630
Mailing Address - Street 1:921 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3535
Mailing Address - Country:US
Mailing Address - Phone:954-670-9630
Mailing Address - Fax:
Practice Address - Street 1:921 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3535
Practice Address - Country:US
Practice Address - Phone:954-670-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL1160343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)