1750366068 NPI number — PROTRANSPORT 1

Table of content: (NPI 1750366068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750366068 NPI number — PROTRANSPORT 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROTRANSPORT 1
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:
1750366068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-2208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-665-4295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6040 COMMERCE BLVD STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROHNERT PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94928-2181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-665-4289
Provider Business Practice Location Address Fax Number:
707-703-4619
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MEISER
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
330-217-2652

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1830 , 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: 292158 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ05021Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ22445Z . This is a "MEDICARE PTN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 352176400 . This is a "ACS US DEPT. OF LABOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MTN01132F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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