Provider Demographics
NPI:1568952554
Name:TREASURE COAST MOBILITY SERVICES
Entity Type:Organization
Organization Name:TREASURE COAST MOBILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CEPHAS
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-403-2077
Mailing Address - Street 1:921 SE HALL ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5613
Mailing Address - Country:US
Mailing Address - Phone:772-403-2077
Mailing Address - Fax:
Practice Address - Street 1:921 SE HALL ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5613
Practice Address - Country:US
Practice Address - Phone:772-403-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)