Healthcare Provider Details

I. General information

NPI: 1396122875
Provider Name (Legal Business Name): ENTERPRISE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PASEO CANADA ST
SAN ANTONIO TX
78232-1112
US

IV. Provider business mailing address

513 PASEO CANADA ST
SAN ANTONIO TX
78232-1112
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-9999
  • Fax: 210-599-1152
Mailing address:
  • Phone: 210-599-9999
  • Fax: 210-599-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL KHADEM
Title or Position: PRESIDENT
Credential:
Phone: 210-669-8294