| Organization Name: | 123 MEDICAL TRANSPORT LLC |
| NPI Number: | 1548522584 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GUSTAVO GUTIERREZ (MANAGER) |
| Mailing Address: | 628 E 19th St Paterson |
| State: | NJ US |
| Postal Code: | 075142805 |
| Phone Number: | 9738511422 |
| Fax Number: | 9739254748 |
| NPI Enumeration Date: | 06/14/2012 |
| NPI Last Update Date: | 09/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 343900000X |
| License Number: | C07814107402782 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Non-emergency Medical Transport (VAN) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |