Provider Demographics
NPI:1184464679
Name:EGON TRANSPORT LLC
Entity type:Organization
Organization Name:EGON TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSEMINARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-453-9740
Mailing Address - Street 1:7425 SPRING RUN DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3571
Mailing Address - Country:US
Mailing Address - Phone:719-453-9740
Mailing Address - Fax:
Practice Address - Street 1:7425 SPRING RUN DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3571
Practice Address - Country:US
Practice Address - Phone:719-453-9740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)