Provider Demographics
NPI:1780383901
Name:MEDINA MEDICAL TRANSPORT CORPORATION
Entity type:Organization
Organization Name:MEDINA MEDICAL TRANSPORT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-355-0201
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:787-355-0201
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 KM 19.8 MARGINAL VILLAS DE LOIZA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-355-0201
Practice Address - Fax:787-500-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTC-AMB-137091OtherAMBULANCE