Provider Demographics
NPI:1437617032
Name:EBENEZER MED TRANSPORT INC.
Entity Type:Organization
Organization Name:EBENEZER MED TRANSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUPERTO
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-375-2894
Mailing Address - Street 1:53 CALLE BRISAS DEL MAR
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-4060
Mailing Address - Country:US
Mailing Address - Phone:787-375-2894
Mailing Address - Fax:
Practice Address - Street 1:BO GUANIQUILLA
Practice Address - Street 2:316 PALMAR NOVOA
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-375-2894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)