Provider Demographics
NPI:1669204186
Name:EXPRESS WHEELCHAIR TRANSPORT, LLC
Entity type:Organization
Organization Name:EXPRESS WHEELCHAIR TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SUID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-318-0498
Mailing Address - Street 1:12001 DR M.L.K JR. STREET NORTH
Mailing Address - Street 2:3803
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716
Mailing Address - Country:US
Mailing Address - Phone:727-318-0498
Mailing Address - Fax:
Practice Address - Street 1:12001 DR M.L.K JR. STREET NORTH
Practice Address - Street 2:3803
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:727-318-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle