MEDICARE: UNIVERSAL MEDICAL TRANSPORTATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	0000121902-0001-7	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144419730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MEDICAL TRANSPORTATION, INC.

Provider Business Mailing Address
First Line	:	212 19TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-2408
Country	:	US
Telephone Number	:	310-559-0888
Fax Number	:	310-559-1568

Provider Business Practice Location Address
First Line	:	3739 OVERLAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6311
Country	:	US
Telephone Number	:	310-559-0888
Fax Number	:	310-559-1568

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. TIMUR RADZHABOV
Credential	:
Telephone Number	:	310-559-0888

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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