Provider Demographics
NPI:1508891714
Name:PREMIER MEDICAL TRANSPORTATION INC.
Entity Type:Organization
Organization Name:PREMIER MEDICAL TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-433-3939
Mailing Address - Street 1:P.O. BOX 690
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-433-3939
Mailing Address - Fax:909-433-3934
Practice Address - Street 1:575 MAPLE COURT
Practice Address - Street 2:SUITE #A
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-433-3939
Practice Address - Fax:909-433-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01064FMedicaid
CAZZZ02927ZMedicare PIN