Provider Demographics
NPI: | 1932426673 |
---|---|
Name: | NORTHWEST MED. TRANS., INC |
Entity Type: | Organization |
Organization Name: | NORTHWEST MED. TRANS., INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | OGANES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ADAMYAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 818-241-3737 |
Mailing Address - Street 1: | 417 ARDEN AVE |
Mailing Address - Street 2: | 211 |
Mailing Address - City: | GLENDALE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91203-4045 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-241-3737 |
Mailing Address - Fax: | 818-548-2474 |
Practice Address - Street 1: | 417 ARDEN AVE |
Practice Address - Street 2: | SUITE 211 |
Practice Address - City: | GLENDALE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91203-4045 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-241-3737 |
Practice Address - Fax: | 818-548-2474 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-04-20 |
Last Update Date: | 2010-04-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | ========= | Medicaid |