1720278179 NPI number — MV TRANSPORTATION

Table of content: (NPI 1720278179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720278179 NPI number — MV TRANSPORTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MV 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:
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:
1720278179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 CAMPUS LANE
Provider Second Line Business Mailing Address:
MV TRANSPORTATION STE #201
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-863-8980
Provider Business Mailing Address Fax Number:
707-863-8712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 TULLY ROAD
Provider Second Line Business Practice Location Address:
MV TRANSPORTATION
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-292-3600
Provider Business Practice Location Address Fax Number:
408-278-9370
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
LUMONT
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
707-863-8709

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: MTN00621F . This is a "MEDI-CAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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