Healthcare Provider Details

I. General information

NPI: 1154719151
Provider Name (Legal Business Name): FREEDOM MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 7TH ST SW STE UNIT4
WINTER HAVEN FL
33880-3836
US

IV. Provider business mailing address

1521 7TH ST SW STE UNIT4
WINTER HAVEN FL
33880-3836
US

V. Phone/Fax

Practice location:
  • Phone: 863-875-4882
  • Fax: 863-875-7904
Mailing address:
  • Phone: 863-875-4882
  • Fax: 863-875-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateFL

VIII. Authorized Official

Name: DAVID KUNBERGER
Title or Position: PRESIDENT
Credential:
Phone: 863-875-4882