Provider Demographics
NPI:1285358531
Name:MEDICAL TRANSPORTATION MANAGEMENT, INC.
Entity type:Organization
Organization Name:MEDICAL TRANSPORTATION MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-561-5686
Mailing Address - Street 1:16 HAWK RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1861
Mailing Address - Country:US
Mailing Address - Phone:636-561-5686
Mailing Address - Fax:
Practice Address - Street 1:16 HAWK RIDGE CIR
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1861
Practice Address - Country:US
Practice Address - Phone:636-561-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO656500006Medicaid