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General NPI Number Information
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NPI Number | 1073648879
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Entity Type | Organization
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Legal Business Name | ARIZONA ROAD-RUNNER SHUTTLE
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2169 SWANSON AVE UNIT 10
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6878
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Country | US
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Telephone | 928-854-9333
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Fax | 928-453-9234
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Provider Business Mailing Address
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Address Line | 2169 SWANSON AVE UNIT 10
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6878
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Country | US
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Telephone | 928-854-9333
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Fax | 928-453-9234
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALLEN DEAN PAYNE
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Credential |
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Telephone | 928-486-5844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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