Provider Demographics
NPI:1598097594
Name:SMART MEDICAL TRANSPORT , LLC
Entity Type:Organization
Organization Name:SMART MEDICAL TRANSPORT , LLC
Other - Org Name:SMART MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICABORDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-954-1124
Mailing Address - Street 1:3802 ROSECRANS ST
Mailing Address - Street 2:SUITE 167
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3114
Mailing Address - Country:US
Mailing Address - Phone:619-954-1124
Mailing Address - Fax:858-246-7768
Practice Address - Street 1:6640 LUSK BLVD
Practice Address - Street 2:SUITE A207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2784
Practice Address - Country:US
Practice Address - Phone:858-246-7767
Practice Address - Fax:858-246-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)