Provider Demographics
NPI:1699846014
Name:FAIRWAY TRANSPORTATION, INC
Entity Type:Organization
Organization Name:FAIRWAY TRANSPORTATION, INC
Other - Org Name:MEDI-VAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHIMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-339-7044
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0746
Mailing Address - Country:US
Mailing Address - Phone:209-333-7800
Mailing Address - Fax:209-369-0520
Practice Address - Street 1:33 MAXWELL ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6320
Practice Address - Country:US
Practice Address - Phone:209-333-7800
Practice Address - Fax:209-333-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01027F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01027FMedicaid