=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407370513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SAMARITAN TRANSPORTATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2017
-----------------------------------------------------
Last Update Date | 07/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5827 COLUMBIA PIKE
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-405-3084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4793 HAWFINCH CT
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22193-3086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-405-3084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GABRIEL MORIBA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-405-3084
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------