Provider Demographics
NPI:1871863928
Name:GREATER TAMPA BAY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GREATER TAMPA BAY TRANSPORTATION LLC
Other - Org Name:EXPRESS MEDICAL TRANSPORTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOTTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-446-0930
Mailing Address - Street 1:12423 62ND ST
Mailing Address - Street 2:#403
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3740
Mailing Address - Country:US
Mailing Address - Phone:727-446-0930
Mailing Address - Fax:727-446-0930
Practice Address - Street 1:12423 62ND ST
Practice Address - Street 2:#403
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3740
Practice Address - Country:US
Practice Address - Phone:727-446-0930
Practice Address - Fax:727-446-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL11000062452343900000X
FLG11000066475343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)