Provider Demographics
NPI:1629442165
Name:JUST LIKE FAMILY CONCIERGE MEDICAL TRANSPORT SERVICES, LLC
Entity Type:Organization
Organization Name:JUST LIKE FAMILY CONCIERGE MEDICAL TRANSPORT SERVICES, LLC
Other - Org Name:BREWSTER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-983-1000
Mailing Address - Street 1:11820 LACY LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1345
Mailing Address - Country:US
Mailing Address - Phone:239-682-8907
Mailing Address - Fax:239-431-9649
Practice Address - Street 1:11820 LACY LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1345
Practice Address - Country:US
Practice Address - Phone:239-682-8907
Practice Address - Fax:239-537-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1629442165Medicaid
FL=========OtherTAX ID