Healthcare Provider Details

I. General information

NPI: 1811602139
Provider Name (Legal Business Name): MBS MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 E 11TH ST
LEHIGH ACRES FL
33972-3776
US

IV. Provider business mailing address

3904 E 11TH ST
LEHIGH ACRES FL
33972-3776
US

V. Phone/Fax

Practice location:
  • Phone: 239-202-4641
  • Fax:
Mailing address:
  • Phone: 239-202-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: DIEUNNETTA MARC
Title or Position: OWNER
Credential:
Phone: 239-202-4641