Provider Demographics
NPI:1184917577
Name:4040I.COM INC
Entity type:Organization
Organization Name:4040I.COM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-880-9626
Mailing Address - Street 1:10524 MOSS PARK RD
Mailing Address - Street 2:SUITE 204-640
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5898
Mailing Address - Country:US
Mailing Address - Phone:888-880-9626
Mailing Address - Fax:630-723-0077
Practice Address - Street 1:10524 MOSS PARK RD
Practice Address - Street 2:SUITE 204-640
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5898
Practice Address - Country:US
Practice Address - Phone:888-880-9626
Practice Address - Fax:630-723-0077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:4040I.COM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG524420730431343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)