Provider Demographics
NPI:1003218967
Name:IMEDIX TRANSPORTATION INC
Entity Type:Organization
Organization Name:IMEDIX TRANSPORTATION INC
Other - Org Name:MED TECH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-324-5710
Mailing Address - Street 1:102 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2434
Mailing Address - Country:US
Mailing Address - Phone:862-324-5710
Mailing Address - Fax:
Practice Address - Street 1:102 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2434
Practice Address - Country:US
Practice Address - Phone:862-324-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)