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General NPI Number Information
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NPI Number | 1194040998
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Entity Type | Organization
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Legal Business Name | MEDSTAR CABULANCE INC
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 614 RAILROAD AVE
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City | ZILLAH
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State | WA
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Zip | 98953
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Country | US
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Telephone | 509-829-6996
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Fax | 509-829-9514
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Provider Business Mailing Address
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Address Line | 1904 FRUITVALE BLVD, YAKIMA, WA 98902
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City | YAKIMA
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State | WA
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Zip | 98902
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Country | US
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Telephone | 509-728-9816
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JUSTIN BERGENER
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Credential |
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Telephone | 509-307-7365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | WA
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