Provider Demographics
NPI:1538615208
Name:1-800MEDIVAN, INC.
Entity type:Organization
Organization Name:1-800MEDIVAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBARDZUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-633-4826
Mailing Address - Street 1:7260 W AZURE DR
Mailing Address - Street 2:#140 STE 2061
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-7999
Mailing Address - Country:US
Mailing Address - Phone:800-633-4826
Mailing Address - Fax:702-941-3021
Practice Address - Street 1:7260 W AZURE DR
Practice Address - Street 2:#140 STE 2061
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-7999
Practice Address - Country:US
Practice Address - Phone:800-633-4826
Practice Address - Fax:702-941-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)