Healthcare Provider Details

I. General information

NPI: 1407604986
Provider Name (Legal Business Name): A.D.I.S TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2692 CREEK RIDGE DR
GREEN COVE SPRINGS FL
32043-6214
US

IV. Provider business mailing address

2692 CREEK RIDGE DR
GREEN COVE SPRINGS FL
32043-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-806-6612
  • Fax: 904-214-3966
Mailing address:
  • Phone: 904-806-6612
  • Fax: 904-214-3966

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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: IRINA REARTES
Title or Position: OWNER
Credential:
Phone: 904-760-2552