MEDICAL TRANSPORTATION MANAGEMENT, INC.

Provider Demographics

• NPI: 1134260078
• Name: MEDICAL TRANSPORTATION MANAGEMENT, INC.
• Entity type: Organization
• Organization Name: MEDICAL TRANSPORTATION MANAGEMENT, INC.
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: PRESIDENT AND CEO
• Authorized Official - First Name: ALAINA
• Authorized Official - Last Name: MACIA
• Authorized Official - Phone: 636-561-5686
• Mailing Address - Street 1: 16 HAWKRIDGE DR
• Mailing Address - City: LAKE ST LOUIS
• Mailing Address - State: MO
• Mailing Address - Zip Code: 63367-1829
• Mailing Address - Country: US
• Mailing Address - Phone: 636-561-5686
• Mailing Address - Fax: 636-561-2962
• Practice Address - Street 1: 16 HAWK RIDGE CIR
• Practice Address - City: LAKE ST LOUIS
• Practice Address - State: MO
• Practice Address - Zip Code: 63367-1861
• Practice Address - Country: US
• Practice Address - Phone: 636-561-5686
• Practice Address - Fax: 636-561-2962
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-12
• Last Update Date: 2024-01-31

Provider Licenses

State	License ID	Taxonomies
		343800000X, 343900000X
MN	8546495000	347E00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	347E00000X	Transportation Services	Transportation Broker
No	343800000X	Transportation Services	Secured Medical Transport (VAN)
No	343900000X	Transportation Services	Non-emergency Medical Transport (VAN)

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	1014658730002	Medicaid
RI	1134260078	Medicaid
FL	14218402-5	Medicaid
TX	335022501-5	Medicaid
MI	8390569	Medicaid
NC	1134260078	Medicaid
OR	500771054	Medicaid
MN	1134260078	Medicaid
FL	14218404-4	Medicaid
MO	1134260078	Medicaid
IA	117509	Medicaid
FL	14218403-3	Medicaid
NH	3123776	Medicaid
NE	10026791901	Medicaid
FL	14218401-6	Medicaid
FL	14218405-7	Medicaid
TX	335021701-9	Medicaid
MS	7034248	Medicaid
NV	1134260078	Medicaid
FL	14218400-8	Medicaid
AR	230483715	Medicaid
NY	2441909	Medicaid