Healthcare Provider Details

I. General information

NPI: 1093646804
Provider Name (Legal Business Name): PRIMECARE MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7943 W ORANGE DR
GLENDALE AZ
85303-5563
US

IV. Provider business mailing address

7943 W ORANGE DR
GLENDALE AZ
85303-5563
US

V. Phone/Fax

Practice location:
  • Phone: 623-800-9402
  • Fax:
Mailing address:
  • Phone: 623-800-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: INDIA JIMMY ISOMANGA
Title or Position: MANAGING MEMBER
Credential: OWNER
Phone: 623-800-9402