Provider Demographics
NPI:1700566262
Name:BOOMERS MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:BOOMERS MEDICAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAISAR
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:ALHAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-748-8882
Mailing Address - Street 1:165 ODDSTAD DR APT 68
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-3425
Mailing Address - Country:US
Mailing Address - Phone:415-748-8882
Mailing Address - Fax:
Practice Address - Street 1:165 ODDSTAD DR APT 68
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-3425
Practice Address - Country:US
Practice Address - Phone:415-748-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)