Provider Demographics
NPI:1073078473
Name:TRAUMA LIFE CARE MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:TRAUMA LIFE CARE MEDICAL TRANSPORT INC
Other - Org Name:TLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEOSUN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-368-2222
Mailing Address - Street 1:3637 MISSION AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-368-2222
Mailing Address - Fax:916-246-8060
Practice Address - Street 1:3637 MISSION AVE STE 4
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2946
Practice Address - Country:US
Practice Address - Phone:916-368-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No333300000XSuppliersEmergency Response System Companies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)