Organization
MV TRANSPORTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY LAMONT RICHARDSON (CFO)
(707) 863-8709
Entity
Organization
Contact information
Practice address
3250 DUTTON AVENUE, SANTA ROSA, CA 95407
(707) 546-1999
(707) 843-0360
Mailing address
360 CAMPUS LANE, STE #201, FAIRFIELD, CA 94534
(707) 863-8980
(707) 863-8712
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN00406F
PROVIDER NUMBER
—
Enumeration date
08/01/2007
Last updated
08/01/2007
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