MEDICARE: GMAR LUX 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	172A00000X	Driver

General Provider Information

NPI Number	:	1477349355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GMAR LUX TRANSPORT LLC

Provider Business Mailing Address
First Line	:	14938 WINDY MOUNT CIR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6728
Country	:	US
Telephone Number	:	407-506-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	5096 DOCKSIDE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2338
Country	:	US
Telephone Number	:	407-506-2870
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GUILLERMO RAFAEL MEDINA
Credential	:
Telephone Number	:	407-506-2870

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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