Provider Demographics
NPI:1992948061
Name:MEMORIAL MEDICAL TRANSPORT, INC
Entity type:Organization
Organization Name:MEMORIAL MEDICAL TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOSELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-961-0155
Mailing Address - Street 1:4525 E ATHERTON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3700
Mailing Address - Country:US
Mailing Address - Phone:888-998-8668
Mailing Address - Fax:562-961-0161
Practice Address - Street 1:4525 E ATHERTON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3700
Practice Address - Country:US
Practice Address - Phone:562-961-0155
Practice Address - Fax:562-961-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)