Provider Demographics
NPI:1043408768
Name:ST. JUDE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:ST. JUDE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-351-9888
Mailing Address - Street 1:10,000 INDIANA AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5419
Mailing Address - Country:US
Mailing Address - Phone:951-351-9888
Mailing Address - Fax:951-351-9888
Practice Address - Street 1:10000 INDIANA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5419
Practice Address - Country:US
Practice Address - Phone:951-351-9888
Practice Address - Fax:951-351-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01260F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)