My Medivan LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

MY MEDIVAN LLC

Practice address

1190 E 5425 S Ste 103
Ogden, UT 84403-5193

Phone

(801) 734-7010

NPI assigned

Mar 17, 2022

Last updated

Mar 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jaquelyn Hernandez, NEMTAC

Title

Managing Director

Phone

(385) 240-9372

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647475200000",
    "number": "1376291419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 E 5425 S STE 103",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035193",
            "telephone_number": "801-734-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 E 5425 S STE 103",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035193",
            "telephone_number": "801-734-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY MEDIVAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JAQUELYN",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "385-240-9372",
        "authorized_official_credential": "NEMTAC"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BALSINGER INSURANCE",
            "identifier": "NPP8569412",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@mymedivan.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1190 E 5425 S Ste 103",
            "city": "Ogden",
            "state": "UT",
            "country_code": "US",
            "postal_code": "844035193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Non-emergency Medical Transport (VAN) in Ogden, UT
• Providers in Ogden, UT by specialty
• Non-emergency Medical Transport (VAN) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.