Provider Demographics
NPI:1386908887
Name:MUSTANG EXPRESS LLC
Entity type:Organization
Organization Name:MUSTANG EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TONIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-264-7193
Mailing Address - Street 1:5034 HERRING CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3473
Mailing Address - Country:US
Mailing Address - Phone:727-264-7193
Mailing Address - Fax:
Practice Address - Street 1:5034 HERRING CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3473
Practice Address - Country:US
Practice Address - Phone:727-264-7193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)