Provider Demographics
NPI:1366701336
Name:LEOPARD TRANSPORT INC
Entity type:Organization
Organization Name:LEOPARD TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-812-1670
Mailing Address - Street 1:PO BOX 1959
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1959
Mailing Address - Country:US
Mailing Address - Phone:352-812-1670
Mailing Address - Fax:352-369-6077
Practice Address - Street 1:1848 NE JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4142
Practice Address - Country:US
Practice Address - Phone:352-812-1670
Practice Address - Fax:352-369-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL099434103Medicaid