Provider Demographics
NPI:1245970821
Name:ADI EXPRESS MEDICAL TRANS LLC
Entity type:Organization
Organization Name:ADI EXPRESS MEDICAL TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WELDEMARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-768-9163
Mailing Address - Street 1:4156 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1182
Mailing Address - Country:US
Mailing Address - Phone:408-768-9163
Mailing Address - Fax:
Practice Address - Street 1:325 PLUS PARK BLVD STE 101G
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1022
Practice Address - Country:US
Practice Address - Phone:408-768-9163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)