Provider Demographics
NPI:1396138467
Name:RIDGECREST MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:RIDGECREST MEDICAL TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-495-2394
Mailing Address - Street 1:1110 W RIDGECREST BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5413
Mailing Address - Country:US
Mailing Address - Phone:760-382-6770
Mailing Address - Fax:760-371-4222
Practice Address - Street 1:1110 W RIDGECREST BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5413
Practice Address - Country:US
Practice Address - Phone:760-382-6770
Practice Address - Fax:760-371-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396138467Medicaid