Provider Demographics
NPI:1659813327
Name:FTA-M
Entity Type:Organization
Organization Name:FTA-M
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:GASIM ZADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-542-8436
Mailing Address - Street 1:9800 BIANCO TER APT 1A
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1635
Mailing Address - Country:US
Mailing Address - Phone:224-542-8436
Mailing Address - Fax:
Practice Address - Street 1:9800 BIANCO TER APT 1A
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1635
Practice Address - Country:US
Practice Address - Phone:224-542-8436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)