Provider Demographics
NPI:1184950065
Name:COVENANT MEDICAL TRANSPORTATION INC
Entity type:Organization
Organization Name:COVENANT MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIM-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:951-662-5504
Mailing Address - Street 1:1400 E COOLEY DR
Mailing Address - Street 2:207
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3939
Mailing Address - Country:US
Mailing Address - Phone:909-498-4087
Mailing Address - Fax:760-514-9043
Practice Address - Street 1:1400 E COOLEY DR
Practice Address - Street 2:207
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3939
Practice Address - Country:US
Practice Address - Phone:909-498-4087
Practice Address - Fax:760-514-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34390000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)