Provider Demographics
NPI:1104300417
Name:TOP MEDICAL TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:TOP MEDICAL TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUPPLICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUFFRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-807-0530
Mailing Address - Street 1:P.O.BOX 822 FORT PIERCE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE FL
Mailing Address - State:FL
Mailing Address - Zip Code:34954
Mailing Address - Country:US
Mailing Address - Phone:772-210-1063
Mailing Address - Fax:
Practice Address - Street 1:105 N 37TH ST FL 34947
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-2503
Practice Address - Country:US
Practice Address - Phone:772-210-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid