Provider Demographics
NPI:1962288696
Name:GEM TRANSPORT LLC
Entity type:Organization
Organization Name:GEM TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN QUILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-283-6881
Mailing Address - Street 1:1200 N MAIN ST UNIT 1261
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-5056
Mailing Address - Country:US
Mailing Address - Phone:208-283-6881
Mailing Address - Fax:
Practice Address - Street 1:1200 N MAIN ST UNIT 1261
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83680-5056
Practice Address - Country:US
Practice Address - Phone:208-283-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)