Healthcare Provider Details

I. General information

NPI: 1235462441
Provider Name (Legal Business Name): MAGIC MISSILE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 N 82ND ST STE201
SCOTTSDALE AZ
85251-2738
US

IV. Provider business mailing address

4354 N 82ND STREET STE201
SCOTTSDALE AZ
85251
US

V. Phone/Fax

Practice location:
  • Phone: 480-381-4262
  • Fax: 480-393-7399
Mailing address:
  • Phone: 480-381-4262
  • Fax: 480-393-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number265580123
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number265580123
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number265580123
License Number StateNY

VIII. Authorized Official

Name: MARK OSYATINSKY
Title or Position: OFFICER
Credential:
Phone: 516-587-1386