Provider Demographics
NPI:1578027520
Name:EAGLE MEDICAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:EAGLE MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GDLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-579-1303
Mailing Address - Street 1:6148 W PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8527
Mailing Address - Country:US
Mailing Address - Phone:559-712-1885
Mailing Address - Fax:559-421-0383
Practice Address - Street 1:6148 W PAUL AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8527
Practice Address - Country:US
Practice Address - Phone:559-712-1885
Practice Address - Fax:559-421-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD2736906Medicaid