Provider Demographics
NPI:1457172876
Name:MEDI TRIP LLC
Entity type:Organization
Organization Name:MEDI TRIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM OUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAMAT AL FATIH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-543-4711
Mailing Address - Street 1:4100 BRIDGEWATER PKWY APT 101
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6102
Mailing Address - Country:US
Mailing Address - Phone:732-543-4711
Mailing Address - Fax:
Practice Address - Street 1:4100 BRIDGEWATER PKWY APT 101
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6102
Practice Address - Country:US
Practice Address - Phone:732-543-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)