Basic Information
| Provider Information | |||||||||
| NPI: | 1164097812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEGASUS TRANSPORT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5506 BEARDSLEY LN | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952197142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155746979 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5506 BEARDSLEY LN | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952197142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155746979 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2021 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | OYEWOLE | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4155746979 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
No ID Information.