Provider Demographics
NPI:1932740727
Name:SKYCOM BROADBAND LLC
Entity Type:Organization
Organization Name:SKYCOM BROADBAND LLC
Other - Org Name:MEDLYFT, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:BOUCHEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-895-7466
Mailing Address - Street 1:11016 FOREST HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-9698
Mailing Address - Country:US
Mailing Address - Phone:540-242-8486
Mailing Address - Fax:540-895-7466
Practice Address - Street 1:11016 FOREST HOLLOW DR
Practice Address - Street 2:
Practice Address - City:BUMPASS
Practice Address - State:VA
Practice Address - Zip Code:23024-9698
Practice Address - Country:US
Practice Address - Phone:540-242-8486
Practice Address - Fax:540-895-7466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKYCOM BROAD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-02
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle