MEDICARE: SUNSHINE EXPRESS TRANSPORT 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	:	1992263594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE EXPRESS TRANSPORT LLC

Provider Business Mailing Address
First Line	:	8010 N CREEK WAY
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-6909
Country	:	US
Telephone Number	:	352-897-4468
Fax Number	:	352-474-2108

Provider Business Practice Location Address
First Line	:	8010 N CREEK WAY
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-6909
Country	:	US
Telephone Number	:	352-897-4468
Fax Number	:	352-474-2108

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	KELLY MAUREEN HUDSON
Credential	:
Telephone Number	:	352-897-4468

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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