Provider Demographics
NPI:1700183472
Name:ALTA MEDICAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:ALTA MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARATKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-897-2582
Mailing Address - Street 1:8502 67TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5214
Mailing Address - Country:US
Mailing Address - Phone:718-897-2582
Mailing Address - Fax:
Practice Address - Street 1:8502 67TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5214
Practice Address - Country:US
Practice Address - Phone:718-897-2582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30718343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03298088Medicaid