Healthcare Provider Details

I. General information

NPI: 1710470687
Provider Name (Legal Business Name): ELITE TRANSPORT SOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 NE 125TH ST
NORTH MIAMI FL
33161-5611
US

IV. Provider business mailing address

707 NE 125TH ST
NORTH MIAMI FL
33161-5611
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-9848
  • Fax: 678-402-7081
Mailing address:
  • Phone: 305-902-9848
  • Fax: 678-402-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ATELUS
Title or Position: OWNER
Credential:
Phone: 305-902-9848