Provider Demographics
NPI:1700033529
Name:PROFESSIONAL MEDICAL TRANSPORTATION CORP
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL TRANSPORTATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-825-8761
Mailing Address - Street 1:7880 W 20TH AVE
Mailing Address - Street 2:SUITE 28
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1896
Mailing Address - Country:US
Mailing Address - Phone:305-825-8761
Mailing Address - Fax:305-825-8762
Practice Address - Street 1:7880 W 20TH AVE
Practice Address - Street 2:SUITE 28
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1896
Practice Address - Country:US
Practice Address - Phone:305-825-8761
Practice Address - Fax:305-825-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410123500Medicaid