Healthcare Provider Details

I. General information

NPI: 1073047452
Provider Name (Legal Business Name): NORTHEAST TRANSPORTATION GROUP LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEALY ST S
ATLANTIC BEACH FL
32233-1960
US

IV. Provider business mailing address

1840 MEALY ST S
ATLANTIC BEACH FL
32233-1960
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-9999
  • Fax: 904-685-6227
Mailing address:
  • Phone: 904-246-9999
  • Fax: 904-685-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA A ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-246-9999