MEDICARE: SOUTH COAST MEDICAL TRANSPORTATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	MTN01267F	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588843817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST MEDICAL TRANSPORTATION, INC.

Provider Business Mailing Address
First Line	:	415 E HARVARD ST
Second Line	:	201
City	:	GLENDALE
State	:	CA
Zip	:	91205-1057
Country	:	US
Telephone Number	:	818-247-8239
Fax Number	:	818-247-8233

Provider Business Practice Location Address
First Line	:	415 E HARVARD ST
Second Line	:	201
City	:	GLENDALE
State	:	CA
Zip	:	91205-1057
Country	:	US
Telephone Number	:	818-247-8239
Fax Number	:	818-247-8233

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. YURI HAMBARDZUMYAN
Credential	:
Telephone Number	:	818-247-8239

Provider Enumeration Date	:	11/03/2007
Last Update Date	:	07/15/2016

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