1992794390 NPI number — MONROE MEDI TRANS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992794390 NPI number — MONROE MEDI TRANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE MEDI TRANS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONROE AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992794390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1669 LYELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14606-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-327-7601
Provider Business Mailing Address Fax Number:
585-454-5182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1669 LYELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14606-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-327-7601
Provider Business Practice Location Address Fax Number:
585-698-2904
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COYLE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
585-327-7601

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  NYS 10572 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X , with the licence number: ALSFR 91054 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343800000X , with the licence number: AMBULANCE NON EMERG , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: CASE 28448 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010065963 . This is a "EXCELLUS BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02991000 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00469154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AM040 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MM . This is a "EXCELLUS BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 911781400F . This is a "FLORIDA MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8190454 . This is a "EVERCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com