=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356535561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CULTOUSTRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2007
-----------------------------------------------------
Last Update Date | 08/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1655 E SOUTHERN AVE APT 45
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-430-6358
-----------------------------------------------------
Fax | 480-461-6670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1655 E SOUTHERN AVE APT 45
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-430-6358
-----------------------------------------------------
Fax | 480-461-6670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. HASSAN M ABDELRAHMAN SR.
-----------------------------------------------------
Credential | 01/01/1982
-----------------------------------------------------
Telephone | 480-430-6358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 393157
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------