Provider Demographics
NPI:1154995595
Name:WILSON AND FAMILY LLC
Entity type:Organization
Organization Name:WILSON AND FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-296-0681
Mailing Address - Street 1:470 SERENITY MILL LOOP
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5618
Mailing Address - Country:US
Mailing Address - Phone:813-296-0681
Mailing Address - Fax:
Practice Address - Street 1:470 SERENITY MILL LOOP
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5618
Practice Address - Country:US
Practice Address - Phone:813-296-0681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)