MEDICARE: NAVAJO TRANS, LLC

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)	L20086745	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215303128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVAJO TRANS, LLC

Provider Business Mailing Address
First Line	:	6402 N 46TH DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-4809
Country	:	US
Telephone Number	:	623-313-3551
Fax Number	:	623-249-7384

Provider Business Practice Location Address
First Line	:	2713 W GEORGIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-2940
Country	:	US
Telephone Number	:	621-331-3355
Fax Number	:	623-249-7384

Authorized Official
Title or Position	:	GENERAL MANAGER /OWNER
Name	:	NENE BITYA ORIHO
Credential	:
Telephone Number	:	623-313-3551

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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Directions to “NAVAJO TRANS, LLC ” Practice Location

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