Provider Demographics
NPI:1508501701
Name:365 MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:365 MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:833-365-8726
Mailing Address - Street 1:802 S CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5866
Mailing Address - Country:US
Mailing Address - Phone:833-365-8726
Mailing Address - Fax:
Practice Address - Street 1:1300 E SHAW AVE STE 149
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7903
Practice Address - Country:US
Practice Address - Phone:833-365-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)