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General NPI Number Information
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NPI Number | 1619262789
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Entity Type | Organization
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Legal Business Name | CMS PROFESSIONAL TRANSPORT, INC.
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 181 SE HERNANDO AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-4428
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Country | US
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Telephone | 386-752-2112
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Fax | 386-758-9047
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Provider Business Mailing Address
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Address Line | PO BOX 2227 181 SE HERNANDO AVE.
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City | LAKE CITY
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State | FL
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Zip | 32056-2227
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Country | US
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Telephone | 386-752-2112
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Fax | 386-758-9047
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRIS SAMSON
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Credential |
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Telephone | 386-752-2112
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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 |
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License Number State | FL
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