Provider Demographics
NPI:1992794390
Name:MONROE MEDI TRANS INC
Entity type:Organization
Organization Name:MONROE MEDI TRANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-327-7601
Mailing Address - Street 1:1669 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2311
Mailing Address - Country:US
Mailing Address - Phone:585-327-7601
Mailing Address - Fax:585-454-5182
Practice Address - Street 1:1669 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2311
Practice Address - Country:US
Practice Address - Phone:585-327-7601
Practice Address - Fax:585-698-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 10572341600000X
NYALSFR 91054341600000X
NYAMBULANCE NON EMERG343800000X
NYCASE 28448343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010065963OtherEXCELLUS BLUE CHOICE
NY02991000Medicaid
NY00469154Medicaid
NYAM040OtherPREFERRED CARE
NYMMOtherEXCELLUS BC/BS
FL911781400FOtherFLORIDA MEDICAID
NY8190454OtherEVERCARE
NY14960BMedicare ID - Type UnspecifiedMEDICARE
NY010065963OtherEXCELLUS BLUE CHOICE