=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477696011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEL-MAR MEDICAL TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 W MAIN ST SUITE 202
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-562-2601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 606
-----------------------------------------------------
City | IMPERIAL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92251-0606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUAN MANUEL BELMAREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-562-2601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------