1861421729 NPI number — MEDTRANS

Table of content: (NPI 1861421729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861421729 NPI number — MEDTRANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDTRANS
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:
MEDTRANS
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:
1861421729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14560 CLARK ST,
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-468-7922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11490 BURBANK BLVD,
Provider Second Line Business Practice Location Address:
#4E
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-4670
Provider Business Practice Location Address Fax Number:
818-986-4628
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BELOBORODOV
Authorized Official First Name:
IGOR
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
818-468-7922

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  64225484 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MTN01141F . This is a "MEDICAL TRANSPORTATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com