1467903898 NPI number — FOOTHILLS MEDICAL TRANSPORT

Table of content: (NPI 1467903898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467903898 NPI number — FOOTHILLS MEDICAL TRANSPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOTHILLS MEDICAL TRANSPORT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467903898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6458 E MARTINSBURG RD
Provider Second Line Business Mailing Address:
LOT 2
Provider Business Mailing Address City Name:
LOWVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13367-4809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-777-5435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6458 E MARTINSBURG RD
Provider Second Line Business Practice Location Address:
LOT 2
Provider Business Practice Location Address City Name:
LOWVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13367-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-777-5435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ALDRICH
Authorized Official First Name:
ALVIN
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
315-777-5435

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  39486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04159904 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com