Provider Demographics
NPI:1790054930
Name:PACIFIC TRANSPORTATION SERVICE LLC
Entity Type:Organization
Organization Name:PACIFIC TRANSPORTATION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ADEMELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ONAMAKINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-597-8734
Mailing Address - Street 1:1501 RANGER LOOP
Mailing Address - Street 2:#204
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5256
Mailing Address - Country:US
Mailing Address - Phone:703-597-8734
Mailing Address - Fax:
Practice Address - Street 1:1501 RANGER LOOP
Practice Address - Street 2:#204
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5256
Practice Address - Country:US
Practice Address - Phone:703-597-8734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA68343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)