Healthcare Provider Details

I. General information

NPI: 1356024327
Provider Name (Legal Business Name): MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8953 S AUBREE CIR
CASA GRANDE AZ
85193-9505
US

IV. Provider business mailing address

8953 S AUBREE CIR
CASA GRANDE AZ
85193-9505
US

V. Phone/Fax

Practice location:
  • Phone: 602-505-2003
  • Fax:
Mailing address:
  • Phone: 602-505-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MARWA ALANNI
Title or Position: CEO
Credential:
Phone: 602-505-2003