1699464396 NPI number — ANGELS MEDICAL TRANSPORTATION SERVICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699464396 NPI number — ANGELS MEDICAL TRANSPORTATION SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS MEDICAL TRANSPORTATION SERVICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANGELS MEDICAL TRANSPORTATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699464396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16295 PALACKY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34604-7821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-797-2336
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16295 PALACKY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34604-7821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-797-2336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
CIRO
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
352-254-0159

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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