1366810467 NPI number — EMPIRE MEDICAL TRANSPORTATION, LLC

Table of content: DR. DANIEL KIM M.D., M.B.A. (NPI 1437507274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366810467 NPI number — EMPIRE MEDICAL TRANSPORTATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPIRE MEDICAL TRANSPORTATION, LLC
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:
Provider Other Organization Name Type Code:
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:
1366810467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70616-6227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-433-5985
Provider Business Mailing Address Fax Number:
337-205-2715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 BRIDLE WOOD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70615-5357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-433-5985
Provider Business Practice Location Address Fax Number:
337-205-2715
Provider Enumeration Date:
09/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
AERIAL
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
337-433-5985

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  2387413 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2387413 . This is a "MOLINA MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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