Provider Demographics
NPI:1093065500
Name:MEDICOACH TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:MEDICOACH TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-710-1360
Mailing Address - Street 1:1201 WESTFORD ST STE U2
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2785
Mailing Address - Country:US
Mailing Address - Phone:978-710-5112
Mailing Address - Fax:
Practice Address - Street 1:1201 WESTFORD ST STE U2
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2785
Practice Address - Country:US
Practice Address - Phone:978-710-5112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)