| NPI | 1245841527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A WALLACE Owner/Operator 813-534-2327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 347C00000X Private Vehicle |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-11 |