Provider Demographics
NPI:1669779880
Name:GEORGES TRANSPORT
Entity type:Organization
Organization Name:GEORGES TRANSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GLENWOOD
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:I
Authorized Official - Credentials:PRES
Authorized Official - Phone:386-456-0640
Mailing Address - Street 1:705 W MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2104
Mailing Address - Country:US
Mailing Address - Phone:386-456-0640
Mailing Address - Fax:386-456-0640
Practice Address - Street 1:705 W MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2104
Practice Address - Country:US
Practice Address - Phone:386-456-0640
Practice Address - Fax:386-456-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT620-307-46-290-0347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681117596Medicaid
FL681117598Medicaid