Provider Demographics
NPI:1407604986
Name:ADIS TRANSPORTATION LLC
Entity type:Organization
Organization Name:ADIS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REARTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-806-6612
Mailing Address - Street 1:2692 CREEK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-6214
Mailing Address - Country:US
Mailing Address - Phone:904-806-6612
Mailing Address - Fax:904-214-3966
Practice Address - Street 1:2692 CREEK RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-6214
Practice Address - Country:US
Practice Address - Phone:904-806-6612
Practice Address - Fax:904-214-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle