Provider Demographics
NPI:1013415173
Name:MARY HUGHES TRANSPORT
Entity Type:Organization
Organization Name:MARY HUGHES TRANSPORT
Other - Org Name:MARY HUGHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-792-1597
Mailing Address - Street 1:4375 SW COUNTY ROAD 152
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-3773
Mailing Address - Country:US
Mailing Address - Phone:386-792-1597
Mailing Address - Fax:386-792-1853
Practice Address - Street 1:4375 SW COUNTY ROAD 152
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-3773
Practice Address - Country:US
Practice Address - Phone:386-792-1597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDKBN63343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)