Provider Demographics
NPI:1447934682
Name:ANTARES MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:ANTARES MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLEEVYA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-271-5765
Mailing Address - Street 1:611 GATEWAY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7066
Mailing Address - Country:US
Mailing Address - Phone:650-271-5765
Mailing Address - Fax:
Practice Address - Street 1:611 GATEWAY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7066
Practice Address - Country:US
Practice Address - Phone:650-271-5765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)