Healthcare Provider Details

I. General information

NPI: 1558191775
Provider Name (Legal Business Name): TRACSAFE MED TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 SPRING POINT CIR
RIVERVIEW FL
33579-4309
US

IV. Provider business mailing address

5475 BUFORD HWY STE C
NORCROSS GA
30071-3987
US

V. Phone/Fax

Practice location:
  • Phone: 312-232-0072
  • Fax: 678-278-1273
Mailing address:
  • Phone: 678-933-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: YASMIN DIAZ
Title or Position: MEMBER
Credential:
Phone: 678-933-9095