=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326607649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDTRANSPORT,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2019
-----------------------------------------------------
Last Update Date | 06/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6850 LAMPSON AVE
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92845-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-303-6653
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6850 LAMPSON AVE
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92845-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-303-6653
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. PETER AWAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-303-6653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------