MEDICARE: GULF AVIATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1902299357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF AVIATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	201 SW MONROE CIR N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-1318
Country	:	US
Telephone Number	:	727-656-1214
Fax Number	:	866-764-8843

Provider Business Practice Location Address
First Line	:	201 SW MONROE CIR N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-1318
Country	:	US
Telephone Number	:	727-656-1214
Fax Number	:	866-764-8843

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL CLAYPOOL
Credential	:	EMT-B
Telephone Number	:	727-656-1214

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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