Provider Demographics
NPI:1588276539
Name:VIP NON EMERGENCY MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:VIP NON EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-760-9298
Mailing Address - Street 1:1040 SAN MARINO AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7936
Mailing Address - Country:US
Mailing Address - Phone:559-760-9298
Mailing Address - Fax:
Practice Address - Street 1:755 N PEACH AVE STE D12
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7257
Practice Address - Country:US
Practice Address - Phone:559-760-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)