Provider Demographics
NPI:1376665687
Name:OUTREACH MEDICAL SERVICE
Entity Type:Organization
Organization Name:OUTREACH MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-332-0300
Mailing Address - Street 1:PO BOX 25545
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-7545
Mailing Address - Country:US
Mailing Address - Phone:201-332-0300
Mailing Address - Fax:973-424-9616
Practice Address - Street 1:845 BERGEN AVE
Practice Address - Street 2:SUITE 323
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4517
Practice Address - Country:US
Practice Address - Phone:201-332-0300
Practice Address - Fax:973-373-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)