Provider Demographics
NPI:1689351405
Name:PRESTIGIOUS TRANSIT LLC
Entity type:Organization
Organization Name:PRESTIGIOUS TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-264-8912
Mailing Address - Street 1:2409 MCWEST ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-7119
Mailing Address - Country:US
Mailing Address - Phone:850-765-0719
Mailing Address - Fax:
Practice Address - Street 1:2409 MCWEST ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-7119
Practice Address - Country:US
Practice Address - Phone:850-765-0719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)