Provider Demographics
NPI:1902936081
Name:EXPRESS MEDICAL TRANSPORTATION INC.
Entity Type:Organization
Organization Name:EXPRESS MEDICAL TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VARTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-946-6964
Mailing Address - Street 1:PO BOX 2037
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-2037
Mailing Address - Country:US
Mailing Address - Phone:909-946-6964
Mailing Address - Fax:909-946-9306
Practice Address - Street 1:155 C ST
Practice Address - Street 2:STE B.
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6090
Practice Address - Country:US
Practice Address - Phone:909-946-6964
Practice Address - Fax:909-946-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342-9430-6343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00326FOtherALLIED HEALTH PROVIDER