Healthcare Provider Details

I. General information

NPI: 1730544040
Provider Name (Legal Business Name): AZ MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 WALNUT ST W
ALLENDALE SC
29810-3662
US

IV. Provider business mailing address

327 WALNUT ST W
ALLENDALE SC
29810-3662
US

V. Phone/Fax

Practice location:
  • Phone: 803-571-8262
  • Fax:
Mailing address:
  • Phone: 803-571-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXIS ZEIDAN
Title or Position: CO OWNER
Credential:
Phone: 803-571-8262