Provider Demographics
NPI:1215773650
Name:PG TRANSPORT AND MOVING SERVICE LLC
Entity type:Organization
Organization Name:PG TRANSPORT AND MOVING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONITTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-601-2922
Mailing Address - Street 1:10208 ALTAVISTA AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3101
Mailing Address - Country:US
Mailing Address - Phone:727-601-2922
Mailing Address - Fax:
Practice Address - Street 1:10208 ALTAVISTA AVE APT 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3101
Practice Address - Country:US
Practice Address - Phone:727-601-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)