Healthcare Provider Details

I. General information

NPI: 1073004537
Provider Name (Legal Business Name): MEDITRIP TRANSPORTATION SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17356 W 12 MILE RD SUITE 202
SOUTHFIELD MI
48085
US

IV. Provider business mailing address

17356 W 12 MILE RD SUITE 202
SOUTHFIELD MI
48076
US

V. Phone/Fax

Practice location:
  • Phone: 248-809-9791
  • Fax: 313-270-7291
Mailing address:
  • Phone: 248-809-9791
  • Fax: 313-270-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. SANDRINE E NYAMBIO
Title or Position: CEO
Credential: RN
Phone: 248-809-9791