Provider Demographics
NPI:1609419258
Name:COMMUNITY MED TRANS, INC
Entity type:Organization
Organization Name:COMMUNITY MED TRANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YENESAW
Authorized Official - Middle Name:WASIHUN
Authorized Official - Last Name:NEGATU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-612-0220
Mailing Address - Street 1:4220 N COLLEGE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-3863
Mailing Address - Country:US
Mailing Address - Phone:559-612-0220
Mailing Address - Fax:
Practice Address - Street 1:4220 N COLLEGE AVE APT A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-3863
Practice Address - Country:US
Practice Address - Phone:559-612-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34390000XMedicaid