Provider Demographics
NPI:1982267480
Name:PROMEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:PROMEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-314-9859
Mailing Address - Street 1:4578 BRANDY OAK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8818
Mailing Address - Country:US
Mailing Address - Phone:787-697-9339
Mailing Address - Fax:904-325-7018
Practice Address - Street 1:4578 BRANDY OAK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8818
Practice Address - Country:US
Practice Address - Phone:904-314-9859
Practice Address - Fax:904-325-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)