Provider Demographics
NPI:1962917161
Name:PRO MED TRANSIT
Entity type:Organization
Organization Name:PRO MED TRANSIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUENTES
Authorized Official - Suffix:JR
Authorized Official - Credentials:EXECUTIVE
Authorized Official - Phone:239-288-9470
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-0516
Mailing Address - Country:US
Mailing Address - Phone:239-288-9470
Mailing Address - Fax:
Practice Address - Street 1:8411 HERON POND DR APT 110
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-8549
Practice Address - Country:US
Practice Address - Phone:239-288-9470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-10
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP532-541-79-263-0347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker