MEDICARE: GO FAM TRANSIT 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1982441671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO FAM TRANSIT LLC

Provider Business Mailing Address
First Line	:	4417 13TH ST # 622
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5058 HATCHINEHA CT
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-8781
Country	:	US
Telephone Number	:	407-906-4080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CYRILLE GUEMBA
Credential	:
Telephone Number	:	407-906-4080

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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