Provider Demographics
NPI:1750702957
Name:MEDINA MEDICAL TRANSPORT EMS CORP.
Entity type:Organization
Organization Name:MEDINA MEDICAL TRANSPORT EMS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-889-0039
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0510
Mailing Address - Country:US
Mailing Address - Phone:787-889-0039
Mailing Address - Fax:787-355-0201
Practice Address - Street 1:PR-3 KM 19.8
Practice Address - Street 2:MARGINAL VILLAS DE LOIZA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-889-0039
Practice Address - Fax:787-355-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-708341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance