Provider Demographics
NPI:1417288010
Name:MED-ONE SHUTTLE, INC.
Entity Type:Organization
Organization Name:MED-ONE SHUTTLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-677-1143
Mailing Address - Street 1:P.O. BOX 730206
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0206
Mailing Address - Country:US
Mailing Address - Phone:386-677-1143
Mailing Address - Fax:386-677-9335
Practice Address - Street 1:3294 W STATE ROAD 40
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-2537
Practice Address - Country:US
Practice Address - Phone:386-677-1143
Practice Address - Fax:386-677-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)