Provider Demographics
NPI:1700908043
Name:COURTEOUS MAV
Entity Type:Organization
Organization Name:COURTEOUS MAV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-725-9164
Mailing Address - Street 1:PO BOX 22392
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-0392
Mailing Address - Country:US
Mailing Address - Phone:973-725-9164
Mailing Address - Fax:973-424-9616
Practice Address - Street 1:6301 MONARCH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1828
Practice Address - Country:US
Practice Address - Phone:973-725-9164
Practice Address - Fax:973-424-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1242928343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)