=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376844332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESERT MOBILE TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2010
-----------------------------------------------------
Last Update Date | 06/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2476 W GOLDMINE MOUNTAIN CV
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-4757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-987-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 133
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-987-6600
-----------------------------------------------------
Fax | 480-926-5377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING DIRECTOR
-----------------------------------------------------
Name | SCOTT MCELHANEY
-----------------------------------------------------
Credential | AZ AHCCCS #586611
-----------------------------------------------------
Telephone | 480-987-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | BU-0025-10
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------