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General NPI Number Information
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NPI Number | 1891817417
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Entity Type | Organization
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Legal Business Name | ISLAND MEDICAL TRANSPORT,INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 CALLE 2 URB JOSE PH HERNANDEZ
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City | RIO GRANDE
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State | PR
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Zip | 00745-3109
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Country | US
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Telephone | 787-574-1203
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 604
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City | RIO GRANDE
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State | PR
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Zip | 00745-0604
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Country | US
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Telephone | 787-547-1203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSE ANGEL LEDUC
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Credential | TEM
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Telephone | 787-547-1203
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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 | 000922
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License Number State | PR
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