=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073017778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANS-MED TRASPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 03/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 WHISPERING OAKS CT APT C
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-6668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-905-8861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 199 AFTON SQ UNIT 111
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32714-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-561-3866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM J PAGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-905-8861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------