Provider Demographics
NPI:1093905358
Name:MV TRANSPORTATION
Entity Type:Organization
Organization Name:MV TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-863-8709
Mailing Address - Street 1:360 CAMPUS LANE
Mailing Address - Street 2:STE #201
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-863-8980
Mailing Address - Fax:707-863-8712
Practice Address - Street 1:10170 CROYDON WAY
Practice Address - Street 2:STE #A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827
Practice Address - Country:US
Practice Address - Phone:916-854-2638
Practice Address - Fax:916-854-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTN00477FOtherPROVIDER NUMBER