Provider Demographics
NPI:1003375163
Name:MEDICITY TRANSPORTATION SERVICE LLC
Entity Type:Organization
Organization Name:MEDICITY TRANSPORTATION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDINASIR
Authorized Official - Middle Name:ADAN
Authorized Official - Last Name:HUSSIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-591-4465
Mailing Address - Street 1:4660 EL CAJON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4465
Mailing Address - Country:US
Mailing Address - Phone:951-591-4465
Mailing Address - Fax:
Practice Address - Street 1:4660 EL CAJON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4465
Practice Address - Country:US
Practice Address - Phone:951-591-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)