Provider Demographics
NPI:1831494624
Name:PREMIUM MEDICAL TRANSPORTATION INC.
Entity Type:Organization
Organization Name:PREMIUM MEDICAL TRANSPORTATION INC.
Other - Org Name:PREMIUM MEDICAL NONEMERGENCY TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-765-6184
Mailing Address - Street 1:606 BLACKSHAW LN
Mailing Address - Street 2:APT-23
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-4503
Mailing Address - Country:US
Mailing Address - Phone:619-662-0563
Mailing Address - Fax:619-662-0567
Practice Address - Street 1:270 E DOUGLAS AVE
Practice Address - Street 2:101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4514
Practice Address - Country:US
Practice Address - Phone:619-662-0563
Practice Address - Fax:619-662-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN468343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)