Provider Demographics
NPI:1619091360
Name:GRANT MEDICAL TRANSPORTATION, INC
Entity Type:Organization
Organization Name:GRANT MEDICAL TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKAVRONECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-613-6427
Mailing Address - Street 1:4351 PINNACLE STREET
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2902
Mailing Address - Country:US
Mailing Address - Phone:941-743-3665
Mailing Address - Fax:941-629-2193
Practice Address - Street 1:4351 PINNACLE STREET
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2902
Practice Address - Country:US
Practice Address - Phone:941-743-3665
Practice Address - Fax:941-629-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086980500Medicaid