Provider Demographics
NPI:1487294153
Name:EMPIRE TRANSPORTATION PROVIDER INC
Entity type:Organization
Organization Name:EMPIRE TRANSPORTATION PROVIDER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABIYU
Authorized Official - Middle Name:KEBEDE
Authorized Official - Last Name:AYNALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:716-533-0824
Mailing Address - Street 1:441 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3919
Mailing Address - Country:US
Mailing Address - Phone:716-400-6900
Mailing Address - Fax:
Practice Address - Street 1:1330 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8900
Practice Address - Country:US
Practice Address - Phone:716-400-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04317837Medicaid
NY04317837OtherNON EMERGENCY MEDICAL TRANSPORTATION