Provider Demographics
NPI:1083102107
Name:MARTIN ELITE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MARTIN ELITE TRANSPORTATION LLC
Other - Org Name:MARTIN ELITE TRNSPORTATION LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEDRIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-575-4612
Mailing Address - Street 1:2919 VALIANT ELM ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8161
Mailing Address - Country:US
Mailing Address - Phone:713-575-4612
Mailing Address - Fax:
Practice Address - Street 1:2919 VALIANT ELM ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545
Practice Address - Country:US
Practice Address - Phone:713-575-4612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)