Healthcare Provider Details

I. General information

NPI: 1023332152
Provider Name (Legal Business Name): SAFETY ONE MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8528 N 43RD DR
GLENDALE AZ
85302-5302
US

IV. Provider business mailing address

8528 N 43RD DR
GLENDALE AZ
85302-5302
US

V. Phone/Fax

Practice location:
  • Phone: 623-217-1559
  • Fax:
Mailing address:
  • Phone: 623-217-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number476336
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number476336
License Number StateAZ

VIII. Authorized Official

Name: MR. ABDELGABAR MOHAMED MOHAMDIAN
Title or Position: OWNER
Credential:
Phone: 623-217-1559