Provider Demographics
NPI:1073917688
Name:ALPHA ONE MEDICAL TRANSIT LLC
Entity Type:Organization
Organization Name:ALPHA ONE MEDICAL TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FUNGAYI
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUNDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-308-3921
Mailing Address - Street 1:25650 BRIARDALE AVE
Mailing Address - Street 2:NONE
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2260
Mailing Address - Country:US
Mailing Address - Phone:440-308-3921
Mailing Address - Fax:
Practice Address - Street 1:25650 BRIARDALE AVE
Practice Address - Street 2:NONE
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2260
Practice Address - Country:US
Practice Address - Phone:440-308-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)