Provider Demographics
NPI:1255376497
Name:AMBITRANS MEDICAL TRANSPORT , INC.
Entity type:Organization
Organization Name:AMBITRANS MEDICAL TRANSPORT , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKAVRONECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-613-6427
Mailing Address - Street 1:4351 PINNACLE ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2902
Mailing Address - Country:US
Mailing Address - Phone:941-743-3665
Mailing Address - Fax:941-629-7314
Practice Address - Street 1:4351 PINNACLE ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2902
Practice Address - Country:US
Practice Address - Phone:941-743-3665
Practice Address - Fax:941-629-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26393416L0300X
FLALS08043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN176070Medicaid
FL400029300Medicaid
FLA0688Medicare ID - Type UnspecifiedMEDICARE
FL590009508Medicare ID - Type UnspecifiedRAILROAD MEDICARE