Healthcare Provider Details

I. General information

NPI: 1255932588
Provider Name (Legal Business Name): GY MED TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 OLD ENGLAND LOOP
SANFORD FL
32771-6581
US

IV. Provider business mailing address

1236 OLD ENGLAND LOOP
SANFORD FL
32771-6581
US

V. Phone/Fax

Practice location:
  • Phone: 407-687-0181
  • Fax:
Mailing address:
  • Phone: 407-687-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: YARLEEN RIVERA
Title or Position: OWNER
Credential:
Phone: 407-687-0181