Provider Demographics
NPI:1730446899
Name:ASAP MEDICAL TRANSPORT
Entity type:Organization
Organization Name:ASAP MEDICAL TRANSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:1909-795-8680
Mailing Address - Street 1:35139 SAN CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5424
Mailing Address - Country:US
Mailing Address - Phone:909-795-8680
Mailing Address - Fax:
Practice Address - Street 1:35139 SAN CARLOS ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5424
Practice Address - Country:US
Practice Address - Phone:909-795-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAR-TEK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)