Provider Demographics
NPI:1477108363
Name:YOUR ANGEL MEDICAL TRANSPORTATION,LLC
Entity Type:Organization
Organization Name:YOUR ANGEL MEDICAL TRANSPORTATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-258-2189
Mailing Address - Street 1:1114 DEWHURST ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-1557
Mailing Address - Country:US
Mailing Address - Phone:941-258-2189
Mailing Address - Fax:941-889-7089
Practice Address - Street 1:1114 DEWHURST ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-1557
Practice Address - Country:US
Practice Address - Phone:941-258-2189
Practice Address - Fax:941-889-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174088876Medicaid