1962917161 NPI number — PRO MED TRANSIT

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 1962917161 NPI number — PRO MED TRANSIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO MED TRANSIT
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:
Provider Other Organization Name Type Code:
6
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:
1962917161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 516
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHIGH ACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33970-0516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-288-9470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8411 HERON POND DR APT 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33972-8549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-288-9470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PUENTES
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPERATIONS
Authorized Official Telephone Number:
239-288-9470

Provider Taxonomy Codes

  • Taxonomy code: 347E00000X , with the licence number:  P532-541-79-263-0 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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