Provider Demographics
NPI:1790067825
Name:AV MEDI, INC.
Entity Type:Organization
Organization Name:AV MEDI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-977-9715
Mailing Address - Street 1:801 E MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2294
Mailing Address - Country:US
Mailing Address - Phone:630-977-9715
Mailing Address - Fax:
Practice Address - Street 1:801 EAST MAIN ST.,
Practice Address - Street 2:SUITE D
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-977-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE REQUIRED343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)