Provider Demographics
NPI:1871199364
Name:MACK WAY TRANSPORTATION
Entity type:Organization
Organization Name:MACK WAY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:USTANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-571-3511
Mailing Address - Street 1:521 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2815
Mailing Address - Country:US
Mailing Address - Phone:415-571-3511
Mailing Address - Fax:
Practice Address - Street 1:521 W OAK ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2815
Practice Address - Country:US
Practice Address - Phone:415-571-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)