Provider Demographics
NPI:1508699679
Name:MEDI GO FL LLC
Entity type:Organization
Organization Name:MEDI GO FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFENNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-808-5665
Mailing Address - Street 1:7512 DR PHILLIPS BLVD STE 50-104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5420
Mailing Address - Country:US
Mailing Address - Phone:407-808-5665
Mailing Address - Fax:
Practice Address - Street 1:16246 CITRUS PKWY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6325
Practice Address - Country:US
Practice Address - Phone:407-808-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)