Provider Demographics
NPI:1871148817
Name:SOUTH BAY MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:SOUTH BAY MEDICAL TRANSPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TANVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-743-0616
Mailing Address - Street 1:2784 HOMESTEAD RD # 101
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5353
Mailing Address - Country:US
Mailing Address - Phone:408-826-8165
Mailing Address - Fax:408-454-6276
Practice Address - Street 1:2784 HOMESTEAD RD # 101
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5353
Practice Address - Country:US
Practice Address - Phone:408-826-8165
Practice Address - Fax:408-454-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)