TMS Management Group, Inc. ("TMS")
Transportation Provider Application

Please fill out the the form below.
* Required Fields

* Company Name
   
Contact Name
    
* First Name
   
* Last Name
   
* Contact Title
   
* Contact Phone Number
   
* Contact Email
   
* Contact Fax Number
   

Company Address
    
* Address Line 1
   
Address Line 2
   
* City
   
* State
   
* Zip
   
* Type of Business
    Corporation
    Partnership
    LLC
    Sole Proprietor
   
* National Provider Identifier (NPI)
(Create a NPI)
   
* Federal Tax ID #
(if Sole Proprietor, SSN#)
   
* (Counties/States)
   

* Do you qualify for your State’s Minority-Owned Business Enterprise (MBE)?
    Yes
    No
   

* Do you qualify for your State’s Women-Owned Business Enterprise (WBE)?
    Yes
    No
   
* Vehicle Liability Insurance - Insurance Company Name:
   
* Limit Amount Per Occurrence:
   
* Limit Amount Per Aggregate:
   
* Personal Liability Insurance - Insurance Company Name:
   
* Limit Amount Per Occurrence:
   
* Limit Amount Per Aggregate:
   
* Type of Service Offered:(check all that apply)
   Ambulatory
   Wheelchair
   Gurney Van
   Stretcher
   Non-Emergency Ambulance
   Fixed Bus Service
   Other
   
* Number of Taxis/Sedans:
   
* Number of Vans:
   
* Number of Stretcher Vehicles:
   
* Number of Non-Emergency Ambulances:
   

* Are you open 24 hours/7 days a week/365 days a year?
    Yes
    No
   

* Do you Provide Same Day Requests for Service?
    Yes
    No
   

* Will your drivers provide assistance to frail or elder passengers, if necessary?
    Yes
    No
   

* Do you provide infant, child or booster car seats?
    Yes
    No
   

* Are any of your Driver's Bilingual?
    Yes
    No
   
Submit

Contact Us

  • 13825 ICOT Blvd.
    Suite 613
    Clearwater, FL 33760
  • Ph: 866–790–8859
  • Fax: 727-252-0933

TMS Receives an Honorable Mention from the FCCC!

Watch the TMS "About Us" Video

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