Provider Demographics
NPI:1306444559
Name:VALLEY MEDTRANS LLC
Entity type:Organization
Organization Name:VALLEY MEDTRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-591-7461
Mailing Address - Street 1:6519 SYLVAN RD APT 217
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5054
Mailing Address - Country:US
Mailing Address - Phone:916-591-7461
Mailing Address - Fax:
Practice Address - Street 1:6519 SYLVAN RD APT 217
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5054
Practice Address - Country:US
Practice Address - Phone:916-591-7461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)