Healthcare Provider Details

I. General information

NPI: 1619262789
Provider Name (Legal Business Name): CMS PROFESSIONAL TRANSPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 SE HERNANDO AVE
LAKE CITY FL
32025-4428
US

IV. Provider business mailing address

PO BOX 2227 181 SE HERNANDO AVE.
LAKE CITY FL
32056-2227
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-2112
  • Fax: 386-758-9047
Mailing address:
  • Phone: 386-752-2112
  • Fax: 386-758-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. CHRIS SAMSON
Title or Position: PRESIDENT
Credential:
Phone: 386-752-2112