1396138467 NPI number — RIDGECREST MEDICAL TRANSPORTATION

Table of content: DR. HYUK MARCUS LEE M.D., (NPI 1740372887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396138467 NPI number — RIDGECREST MEDICAL TRANSPORTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGECREST MEDICAL TRANSPORTATION
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:
6
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:
1396138467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 W RIDGECREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGECREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93555-5413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-382-6770
Provider Business Mailing Address Fax Number:
760-371-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 W RIDGECREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-382-6770
Provider Business Practice Location Address Fax Number:
760-371-4222
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BOSKE
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
760-495-2394

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1396138467 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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