Provider Demographics
NPI:1215401294
Name:SHOWTIME TRANSPORTATION CORP
Entity Type:Organization
Organization Name:SHOWTIME TRANSPORTATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-508-6889
Mailing Address - Street 1:161 BRIGHTON 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5368
Mailing Address - Country:US
Mailing Address - Phone:718-260-6666
Mailing Address - Fax:
Practice Address - Street 1:161 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5368
Practice Address - Country:US
Practice Address - Phone:718-260-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0494-1631Medicaid