Provider Demographics
NPI:1366149908
Name:SMK MEDICAL TRANSPORT SERVICES
Entity type:Organization
Organization Name:SMK MEDICAL TRANSPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KATASKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:800-962-2751
Mailing Address - Street 1:208 OAKFIELD DR # 1107
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5707
Mailing Address - Country:US
Mailing Address - Phone:800-962-2751
Mailing Address - Fax:
Practice Address - Street 1:208 OAKFIELD DR # 1107
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5707
Practice Address - Country:US
Practice Address - Phone:800-962-2751
Practice Address - Fax:800-962-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)