MEDICARE: ARIZONA ROAD-RUNNER SHUTTLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	098350	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1073648879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA ROAD-RUNNER SHUTTLE

Provider Business Mailing Address
First Line	:	2169 SWANSON AVE
Second Line	:	UNIT 10
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6878
Country	:	US
Telephone Number	:	928-854-9333
Fax Number	:	928-453-9234

Provider Business Practice Location Address
First Line	:	2169 SWANSON AVE
Second Line	:	UNIT 10
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6878
Country	:	US
Telephone Number	:	928-854-9333
Fax Number	:	928-453-9234

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALLEN DEAN PAYNE
Credential	:
Telephone Number	:	928-486-5844

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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Directions to “ARIZONA ROAD-RUNNER SHUTTLE ” Practice Location

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