Provider Demographics
NPI:1497206452
Name:OLYMPIC MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:OLYMPIC MEDICAL TRANSPORTATION LLC
Other - Org Name:DAUD MOHAMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAUD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-908-3768
Mailing Address - Street 1:5707 CRENSHAW RD APT K
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2538
Mailing Address - Country:US
Mailing Address - Phone:804-908-3768
Mailing Address - Fax:
Practice Address - Street 1:5707 CRENSHAW RD APT K
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2538
Practice Address - Country:US
Practice Address - Phone:804-908-3768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAUD MOHAMED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00200500544343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)