Provider Demographics
NPI:1093697443
Name:MAGNIFICENT VAN TRANSPORTATION
Entity type:Organization
Organization Name:MAGNIFICENT VAN TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-465-1475
Mailing Address - Street 1:132 W MENNONITE RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9238
Mailing Address - Country:US
Mailing Address - Phone:765-465-1475
Mailing Address - Fax:
Practice Address - Street 1:19101 LOCHERIE AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1409
Practice Address - Country:US
Practice Address - Phone:765-465-1475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)