Provider Demographics
NPI:1154832673
Name:ETERNAL MEDICAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:ETERNAL MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIROS
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SEMIRDZJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-400-2900
Mailing Address - Street 1:313 E BROADWAY UNIT 214
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-7013
Mailing Address - Country:US
Mailing Address - Phone:818-400-2900
Mailing Address - Fax:818-245-6406
Practice Address - Street 1:313 E BROADWAY UNIT 214
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91209-7013
Practice Address - Country:US
Practice Address - Phone:818-400-2900
Practice Address - Fax:818-245-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)