Provider Demographics
NPI:1699464396
Name:ANGELS MEDICAL TRANSPORTATION SERVICE LLC
Entity type:Organization
Organization Name:ANGELS MEDICAL TRANSPORTATION SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:CIRO
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-254-0159
Mailing Address - Street 1:16295 PALACKY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-7821
Mailing Address - Country:US
Mailing Address - Phone:352-797-2336
Mailing Address - Fax:
Practice Address - Street 1:16295 PALACKY ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-7821
Practice Address - Country:US
Practice Address - Phone:352-797-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)