Provider Demographics
NPI:1578344610
Name:FORNEY MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:FORNEY MEDICAL TRANSPORTATION LLC
Other - Org Name:FORNEY MEDICAL TRANSPORTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HABEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TESFALIDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-809-9957
Mailing Address - Street 1:4119 WALDRON TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3119
Mailing Address - Country:US
Mailing Address - Phone:773-809-9957
Mailing Address - Fax:
Practice Address - Street 1:4119 WALDRON TRL
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3119
Practice Address - Country:US
Practice Address - Phone:773-809-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker