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General NPI Number Information
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NPI Number | 1790262103
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Entity Type | Organization
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Legal Business Name | GO LOGIX LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 911 S WOODROW WILSON ST STE 7
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City | PLANT CITY
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State | FL
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Zip | 33563-9301
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Country | US
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Telephone | 813-335-2028
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 E STATE ROAD 60 UNIT 58
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City | VALRICO
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State | FL
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Zip | 33595-8004
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Country | US
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Telephone | 813-335-2028
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. SCOTT WAXLER
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Credential |
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Telephone | 813-335-2028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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