Provider Demographics
NPI:1093136780
Name:ALTA MODA MEDICAL SERVICES LC
Entity Type:Organization
Organization Name:ALTA MODA MEDICAL SERVICES LC
Other - Org Name:ALTA MODA MEDICAL TRANSPORTATION LC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIAZIZ
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAJIABDIRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-310-9128
Mailing Address - Street 1:224 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-2128
Mailing Address - Country:US
Mailing Address - Phone:319-310-9128
Mailing Address - Fax:
Practice Address - Street 1:708 J AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4520
Practice Address - Country:US
Practice Address - Phone:319-365-1382
Practice Address - Fax:319-365-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)