MEDICARE: G&S STATE TRANSPORT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1124652623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G&S STATE TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	9428 BAYMEADOWS RD STE 134
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7970
Country	:	US
Telephone Number	:	904-379-0234
Fax Number	:	904-379-3285

Provider Business Practice Location Address
First Line	:	9428 BAYMEADOWS RD STE 134
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7970
Country	:	US
Telephone Number	:	904-379-0234
Fax Number	:	904-379-3285

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SEVENY MAE STATE
Credential	:	PROVIDER
Telephone Number	:	904-392-9380

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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