Provider Demographics
NPI:1962544650
Name:MIDWAY CARE MEDICAL TRANSPORTATION INC
Entity type:Organization
Organization Name:MIDWAY CARE MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA CORAZON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-863-6651
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1209
Mailing Address - Country:US
Mailing Address - Phone:562-863-6651
Mailing Address - Fax:562-863-7751
Practice Address - Street 1:20134 STATE RD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6457
Practice Address - Country:US
Practice Address - Phone:562-863-6651
Practice Address - Fax:562-863-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1925165343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00788FMedicaid