Provider Demographics
NPI:1710313622
Name:PATIENT TRANSPORTATION INC
Entity Type:Organization
Organization Name:PATIENT TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDOLLAH
Authorized Official - Middle Name:KHANI
Authorized Official - Last Name:HADAVAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-279-3953
Mailing Address - Street 1:1927 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2883
Mailing Address - Country:US
Mailing Address - Phone:304-264-0119
Mailing Address - Fax:
Practice Address - Street 1:1927 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2883
Practice Address - Country:US
Practice Address - Phone:304-264-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV602683416L0300X
WV1107746808343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ467000001OtherMEDICARE PTAN
WV3910005897Medicaid
WV9030043000Medicaid