Provider Demographics
NPI:1861853228
Name:MARIANAS MEDICAL RESPONSE LLC
Entity Type:Organization
Organization Name:MARIANAS MEDICAL RESPONSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC JAMES
Authorized Official - Middle Name:SHOLING
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-989-7667
Mailing Address - Street 1:PO BOX 24113
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-4113
Mailing Address - Country:US
Mailing Address - Phone:671-989-7667
Mailing Address - Fax:
Practice Address - Street 1:107 CAMACHO ST.
Practice Address - Street 2:
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913-9998
Practice Address - Country:US
Practice Address - Phone:671-989-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)