Healthcare Provider Details

I. General information

NPI: 1639003726
Provider Name (Legal Business Name): AMIGO MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 DAIQUIRI AVE NE
SALEM OR
97301-5223
US

IV. Provider business mailing address

4706 DAIQUIRI AVE NE
SALEM OR
97301-5223
US

V. Phone/Fax

Practice location:
  • Phone: 213-842-5016
  • Fax:
Mailing address:
  • Phone: 213-842-5016
  • 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: JAIME ANDRES MUNOZ
Title or Position: MANAGER
Credential:
Phone: 213-842-5016