Provider Demographics
NPI:1689365249
Name:BLACK SWAN MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:BLACK SWAN MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-679-7823
Mailing Address - Street 1:39851 JERRY RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-7101
Mailing Address - Country:US
Mailing Address - Phone:813-679-7823
Mailing Address - Fax:
Practice Address - Street 1:39851 JERRY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-7101
Practice Address - Country:US
Practice Address - Phone:813-679-7823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)