Provider Demographics
NPI:1558479543
Name:DESERT VALLEY MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:DESERT VALLEY MEDICAL TRANSPORT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 55418
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5418
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:14828 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4024
Practice Address - Country:US
Practice Address - Phone:760-952-7400
Practice Address - Fax:760-245-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00821FOtherMOLINA HEALTH PLAN
CACA0000D100270OtherSECTION 1011
CAZZZ54045ZOtherBS OF CA
CA012835OtherSCAN HEALTH PLAN
CA126490800OtherWORKERS' COMP DEPT OF LAB
CAMTE00921FMedicaid
CAZZZ54045ZOtherBS OF CA
CAZZZ54045ZOtherBS OF CA
CA=========923950000OtherCHAMPUS/TRICARE