Provider Demographics
NPI:1457750242
Name:MEDI-TRANSPORTATION
Entity type:Organization
Organization Name:MEDI-TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-632-1389
Mailing Address - Street 1:9610 RICH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JODIE
Mailing Address - State:WV
Mailing Address - Zip Code:26690-6042
Mailing Address - Country:US
Mailing Address - Phone:304-632-1389
Mailing Address - Fax:
Practice Address - Street 1:9610 RICH CREEK RD
Practice Address - Street 2:
Practice Address - City:JODIE
Practice Address - State:WV
Practice Address - Zip Code:26690-6042
Practice Address - Country:US
Practice Address - Phone:304-632-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)