Provider Demographics
NPI:1427452697
Name:MEDI-TRAN NON-EMERGENCY MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:MEDI-TRAN NON-EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-971-0184
Mailing Address - Street 1:2005 BROADWAY ST STE 115
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-1945
Mailing Address - Country:US
Mailing Address - Phone:832-971-0184
Mailing Address - Fax:866-891-4447
Practice Address - Street 1:2005 BROADWAY ST STE 115
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-1945
Practice Address - Country:US
Practice Address - Phone:832-971-0184
Practice Address - Fax:866-891-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)