Provider Demographics
NPI:1821637018
Name:SECURED ONE TRANSPORT LLC
Entity Type:Organization
Organization Name:SECURED ONE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-468-9744
Mailing Address - Street 1:8165 NW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5204
Mailing Address - Country:US
Mailing Address - Phone:786-468-9744
Mailing Address - Fax:786-391-2082
Practice Address - Street 1:8165 NW 192ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5204
Practice Address - Country:US
Practice Address - Phone:786-468-9744
Practice Address - Fax:786-391-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)