MEDICARE: GEOGRAPHIC TRANSPORT, INC

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	:	1891348579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEOGRAPHIC TRANSPORT, INC

Provider Business Mailing Address
First Line	:	19924 TAMIAMI AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3365
Country	:	US
Telephone Number	:	813-504-9074
Fax Number	:	813-354-4463

Provider Business Practice Location Address
First Line	:	10407 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6824
Country	:	US
Telephone Number	:	813-504-9074
Fax Number	:	813-354-4463

Authorized Official
Title or Position	:	OWNER
Name	:	MIKENSON ARISTIL
Credential	:
Telephone Number	:	813-504-9074

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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