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General NPI Number Information
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NPI Number | 1699305474
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Entity Type | Organization
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Legal Business Name | ROMAN DESTINATION TRANSPORTATION LLC
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 1499 GUARDIAN DR
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City | JACKSONVILLE
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State | FL
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Zip | 32221-8028
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Country | US
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Telephone | 904-891-1828
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Fax | 904-580-5197
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Provider Business Mailing Address
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Address Line | 1499 GUARDIAN DR
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City | JACKSONVILLE
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State | FL
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Zip | 32221-8028
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Country | US
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Telephone | 904-891-1828
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Fax | 904-580-5197
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Authorized Official
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Title or Position | GENERAL MANAGER/AGENT/OWNER
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Name | CHERYLE W ROMAN
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Credential | MASTER OF EDUCATION
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Telephone | 904-891-1828
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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 |
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