Provider Demographics
NPI:1861421729
Name:MEDTRANS
Entity type:Organization
Organization Name:MEDTRANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BELOBORODOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-468-7922
Mailing Address - Street 1:14560 CLARK ST,
Mailing Address - Street 2:#201
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411
Mailing Address - Country:US
Mailing Address - Phone:818-468-7922
Mailing Address - Fax:
Practice Address - Street 1:11490 BURBANK BLVD,
Practice Address - Street 2:#4E
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601
Practice Address - Country:US
Practice Address - Phone:818-783-4670
Practice Address - Fax:818-986-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64225484343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01141FOtherMEDICAL TRANSPORTATION