Provider Demographics
NPI:1538816491
Name:MEDICPLUS TRANSPORT
Entity type:Organization
Organization Name:MEDICPLUS TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IANIRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACHECO SOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-286-7845
Mailing Address - Street 1:417 CALLE PADRE RIVERA
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-5834
Mailing Address - Country:US
Mailing Address - Phone:787-964-1467
Mailing Address - Fax:
Practice Address - Street 1:SECTOR VILLA LAGUNA 462
Practice Address - Street 2:CARR 690 BO SABANA HOYOS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-964-1467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR01234Medicaid