Provider Demographics
NPI:1902654593
Name:MEDI-TREK LLC
Entity Type:Organization
Organization Name:MEDI-TREK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-969-0909
Mailing Address - Street 1:101 SOUTHEAST PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5845
Mailing Address - Country:US
Mailing Address - Phone:765-969-0909
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTHEAST PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5845
Practice Address - Country:US
Practice Address - Phone:765-969-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)