Provider Demographics
NPI:1568544534
Name:MAGTRANS, INC
Entity Type:Organization
Organization Name:MAGTRANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:POVOLOTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-851-9100
Mailing Address - Street 1:2065 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5222
Mailing Address - Country:US
Mailing Address - Phone:323-851-9100
Mailing Address - Fax:323-766-0900
Practice Address - Street 1:2065 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5222
Practice Address - Country:US
Practice Address - Phone:323-851-9100
Practice Address - Fax:323-766-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01156F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01156FMedicaid