Provider Demographics
NPI:1760240618
Name:MEDIVOY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MEDIVOY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-494-6381
Mailing Address - Street 1:1209 CENTRAL AVE S STE 208
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7436
Mailing Address - Country:US
Mailing Address - Phone:832-494-6381
Mailing Address - Fax:
Practice Address - Street 1:1209 CENTRAL AVE S STE 208
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7436
Practice Address - Country:US
Practice Address - Phone:832-494-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)