Healthcare Provider Details

I. General information

NPI: 1225366511
Provider Name (Legal Business Name): MEDIATION PRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N WESTSHORE BLVD SUITE 110
TAMPA FL
33607-4515
US

IV. Provider business mailing address

1411 N WESTSHORE BLVD SUITE 110
TAMPA FL
33607-4515
US

V. Phone/Fax

Practice location:
  • Phone: 888-939-7767
  • Fax: 866-507-8362
Mailing address:
  • Phone: 888-939-7767
  • Fax: 866-507-8362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. KASEY L KIMBROUGH
Title or Position: PRESIDENT / CEO
Credential:
Phone: 888-939-7767