Provider Demographics
NPI:1104384700
Name:MIMI TRANSPORTATION S CORPORATION
Entity Type:Organization
Organization Name:MIMI TRANSPORTATION S CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YENENASH
Authorized Official - Middle Name:T
Authorized Official - Last Name:BADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-334-7032
Mailing Address - Street 1:7608 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6402
Mailing Address - Country:US
Mailing Address - Phone:804-513-8472
Mailing Address - Fax:804-904-2029
Practice Address - Street 1:7608 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6402
Practice Address - Country:US
Practice Address - Phone:804-525-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)