Provider Demographics
NPI:1396223863
Name:MEDIVAN LLC
Entity Type:Organization
Organization Name:MEDIVAN LLC
Other - Org Name:THE MEDIVAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OFFICIAL SIGNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCKENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-338-0353
Mailing Address - Street 1:520 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4128
Mailing Address - Country:US
Mailing Address - Phone:810-338-0353
Mailing Address - Fax:
Practice Address - Street 1:520 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4128
Practice Address - Country:US
Practice Address - Phone:810-338-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)