Provider Demographics
NPI:1366752669
Name:ULTRA TRANSPORTATION INC
Entity type:Organization
Organization Name:ULTRA TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GALIBOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-779-1628
Mailing Address - Street 1:10780 LOCKART RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3132
Mailing Address - Country:US
Mailing Address - Phone:215-779-1628
Mailing Address - Fax:215-947-6667
Practice Address - Street 1:10780 LOCKART RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3132
Practice Address - Country:US
Practice Address - Phone:215-779-1628
Practice Address - Fax:215-947-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)