Provider Demographics
NPI:1619262789
Name:CMS PROFESSIONAL TRANSPORT, INC.
Entity Type:Organization
Organization Name:CMS PROFESSIONAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-752-2112
Mailing Address - Street 1:PO BOX 2227
Mailing Address - Street 2:181 SE HERNANDO AVE.
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-2227
Mailing Address - Country:US
Mailing Address - Phone:386-752-2112
Mailing Address - Fax:386-758-9047
Practice Address - Street 1:181 SE HERNANDO AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4428
Practice Address - Country:US
Practice Address - Phone:386-752-2112
Practice Address - Fax:386-758-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)