Provider Demographics
NPI:1093175333
Name:OAK CLIFF MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:OAK CLIFF MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEWODROS
Authorized Official - Middle Name:BEKELE
Authorized Official - Last Name:TIKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-730-8809
Mailing Address - Street 1:3951 GRAY OAK PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-1591
Mailing Address - Country:US
Mailing Address - Phone:214-730-8809
Mailing Address - Fax:214-378-9249
Practice Address - Street 1:3951 GRAY OAK PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-1591
Practice Address - Country:US
Practice Address - Phone:214-730-8809
Practice Address - Fax:214-378-9249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK CLIFF MEDICAL TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02708181343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8809Medicaid