Provider Demographics
NPI:1134821812
Name:SOUTHWEST MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:SOUTHWEST MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GIORGI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-203-5137
Mailing Address - Street 1:21108 STANWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2350
Mailing Address - Country:US
Mailing Address - Phone:818-612-7549
Mailing Address - Fax:818-698-6574
Practice Address - Street 1:21108 STANWELL ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2350
Practice Address - Country:US
Practice Address - Phone:818-612-7549
Practice Address - Fax:818-698-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle