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General NPI Number Information
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NPI Number | 1033588769
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Entity Type | Organization
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Legal Business Name | CLARK TRANSPORT LLC
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 41152 GRAND RIDGE DR
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City | UMATILLA
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State | FL
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Zip | 32784-8662
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Country | US
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Telephone | 352-434-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 41152 GRAND RIDGE DR
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City | UMATILLA
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State | FL
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Zip | 32784-8662
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Country | US
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Telephone | 352-434-1062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARRETT CLARK
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Credential |
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Telephone | 352-434-1062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 8760040398
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License Number State | FL
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