Provider Demographics
NPI:1215518923
Name:CITY MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:CITY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALESAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-725-7774
Mailing Address - Street 1:5 AVE NATIVO ALERS UNIT 568
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0568
Mailing Address - Country:US
Mailing Address - Phone:973-725-7774
Mailing Address - Fax:973-366-6241
Practice Address - Street 1:CARR 4115 KM 0.1
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:973-725-7774
Practice Address - Fax:973-366-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No343800000XTransportation ServicesSecured Medical Transport (VAN)