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General NPI Number Information
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NPI Number | 1053671057
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Entity Type | Organization
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Legal Business Name | EAGLE TRANSPORT LLC
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 14360 SE 96TH CT
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City | SUMMERFIELD
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State | FL
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Zip | 34491-3616
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Country | US
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Telephone | 352-427-7723
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Fax | 877-281-7652
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Provider Business Mailing Address
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Address Line | 14360 SE 96TH CT
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City | SUMMERFIELD
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State | FL
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Zip | 34491-3616
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Country | US
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Telephone | 352-427-7723
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Fax | 877-281-7652
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Authorized Official
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Title or Position | SOLE MEMBER LLC
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Name | MR. CURTISS STEVEN BESLEY
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Credential |
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Telephone | 352-266-6760
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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 | 6
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License Number State | FL
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