Organization
FAIRWAY TRANSPORTATION, INC
Active
Other names
Medi-Van
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PERRY D. SCHIMKE (CEO)
(209) 339-7044
Entity
Organization
Contact information
Practice address
33 MAXWELL ST, LODI, CA 95240-6320
(209) 333-7800
(209) 333-7887
Mailing address
PO BOX 746, WOODBRIDGE, CA 95258-0746
(209) 333-7800
(209) 369-0520
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
MTN01027F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MTN01027F
—
CA
Enumeration date
11/10/2006
Last updated
08/22/2020
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