Healthcare Provider Details

I. General information

NPI: 1033690078
Provider Name (Legal Business Name): LGC MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 GALL BLVD STE 201C
ZEPHYRHILLS FL
33542-2569
US

IV. Provider business mailing address

6719 GALL BLVD STE 201C
ZEPHYRHILLS FL
33542-2569
US

V. Phone/Fax

Practice location:
  • Phone: 813-528-3692
  • Fax:
Mailing address:
  • Phone: 813-528-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateFL

VIII. Authorized Official

Name: LUIS GERONIMO GUEVARA
Title or Position: OWNER
Credential: ENGINEER OWNER
Phone: 813-528-3692