Provider Demographics
NPI:1679070890
Name:WB MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:WB MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:READERMS
Authorized Official - Middle Name:
Authorized Official - Last Name:BREVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-827-8877
Mailing Address - Street 1:177 SW HAWTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 SW HAWTHORNE CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3531
Practice Address - Country:US
Practice Address - Phone:561-827-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)