=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568996643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SE FLORIDA TRANSPORTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2017
-----------------------------------------------------
Last Update Date | 04/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 N FLORIDA MANGO RD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-5214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-242-6400
-----------------------------------------------------
Fax | 561-689-6255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 N FLORIDA MANGO RD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-5214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-242-6400
-----------------------------------------------------
Fax | 561-689-6255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | DOMINICK V TOCCI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-242-6402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | VHF110
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------