Healthcare Provider Details

I. General information

NPI: 1952987885
Provider Name (Legal Business Name): TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 SHORTY RD
AUBURNDALE FL
33823-9596
US

IV. Provider business mailing address

2428 SHORTY RD
AUBURNDALE FL
33823-9596
US

V. Phone/Fax

Practice location:
  • Phone: 863-440-4412
  • Fax:
Mailing address:
  • Phone: 863-440-4412
  • Fax:

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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: CHARITA SMITH
Title or Position: OWNER
Credential:
Phone: 863-440-4412