Provider Demographics
NPI:1386946499
Name:MORENA TRANSPORT SERVICE
Entity type:Organization
Organization Name:MORENA TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-361-0652
Mailing Address - Street 1:24 BANYAN PASS
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8779
Mailing Address - Country:US
Mailing Address - Phone:352-361-0652
Mailing Address - Fax:
Practice Address - Street 1:24 BANYAN PASS
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8779
Practice Address - Country:US
Practice Address - Phone:352-361-0652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)