Healthcare Provider Details

I. General information

NPI: 1336914837
Provider Name (Legal Business Name): SHALASH MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6449 W GLENDALE AVE
GLENDALE AZ
85301-2310
US

IV. Provider business mailing address

1920 W KINFIELD TRL
PHOENIX AZ
85085-8674
US

V. Phone/Fax

Practice location:
  • Phone: 614-271-0330
  • Fax:
Mailing address:
  • Phone: 614-271-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: HUSAM SHALASH
Title or Position: OWNER
Credential:
Phone: 614-271-0330