Provider Demographics
NPI:1922659457
Name:FLOMAJAX TRANSPORT
Entity Type:Organization
Organization Name:FLOMAJAX TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-328-6917
Mailing Address - Street 1:4059 WINDY GALE DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4425
Mailing Address - Country:US
Mailing Address - Phone:904-328-6917
Mailing Address - Fax:
Practice Address - Street 1:4059 WINDY GALE DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4425
Practice Address - Country:US
Practice Address - Phone:904-328-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOMAJAX LOGISTICS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)