Provider Demographics
NPI:1427223635
Name:INNOVATIVE MEDICAL TRANSPORT SERVICES
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL TRANSPORT SERVICES
Other - Org Name:IMED TRANSPORT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FAUSTINO
Authorized Official - Last Name:KALUGDAN
Authorized Official - Suffix:I
Authorized Official - Credentials:RN
Authorized Official - Phone:909-273-1444
Mailing Address - Street 1:1513 E ELMA PRIVADO
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4434
Mailing Address - Country:US
Mailing Address - Phone:909-273-1444
Mailing Address - Fax:909-933-2721
Practice Address - Street 1:1513 E ELMA PRIVADO
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4434
Practice Address - Country:US
Practice Address - Phone:909-273-1444
Practice Address - Fax:909-933-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL00069556343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)