Provider Demographics
NPI:1841637402
Name:EBENDRISS, YAHIA ALIOSMAN
Entity type:Individual
Prefix:MR
First Name:YAHIA
Middle Name:ALIOSMAN
Last Name:EBENDRISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49041
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-1041
Mailing Address - Country:US
Mailing Address - Phone:336-450-6782
Mailing Address - Fax:
Practice Address - Street 1:4615 BROMPTON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1205
Practice Address - Country:US
Practice Address - Phone:336-450-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23671618343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)