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General NPI Number Information
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NPI Number | 1346128246
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Entity Type | Organization
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Legal Business Name | PANTHER MOUNTAIN ENTERPRISES LLC
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 410 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4203
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Country | US
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Telephone | 863-412-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 470 CITI CTR ST STE 1262
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3425
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Country | US
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Telephone | 863-412-6434
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN KINCAID JR.
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Credential |
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Telephone | 863-412-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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