Provider Demographics
NPI:1902305287
Name:SUPREME MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:SUPREME MEDICAL TRANSPORT INC
Other - Org Name:SUPREME MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-508-8560
Mailing Address - Street 1:3130 BONITA RD STE 200C
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3263
Mailing Address - Country:US
Mailing Address - Phone:619-508-8560
Mailing Address - Fax:619-662-0567
Practice Address - Street 1:3130 BONITA RD STE 200C
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3263
Practice Address - Country:US
Practice Address - Phone:619-508-8560
Practice Address - Fax:619-662-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN770343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)