Provider Demographics
NPI:1134867690
Name:BLACK COACH TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:BLACK COACH TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-461-7174
Mailing Address - Street 1:500 GILLIAM ST APT A2
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4658
Mailing Address - Country:US
Mailing Address - Phone:352-461-7174
Mailing Address - Fax:
Practice Address - Street 1:500 GILLIAM ST APT A2
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4658
Practice Address - Country:US
Practice Address - Phone:352-461-7174
Practice Address - Fax:352-748-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle