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General NPI Number Information
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NPI Number | 1871826578
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Entity Type | Organization
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Legal Business Name | CHICAGO MEDICAL TRANSPORTATION
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Dates
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Enumeration Date | 09/13/2009
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Last Update Date | 09/13/2009
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Provider Practice Location Address
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Address Line | 1753 E BROADWAY RD STE 101 #309
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City | TEMPE
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State | AZ
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Zip | 85282-2081
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Country | US
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Telephone | 480-232-1935
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Fax |
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Provider Business Mailing Address
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Address Line | 1753 E BROADWAY RD STE 101 #309
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City | TEMPE
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State | AZ
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Zip | 85282-2081
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Country | US
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Telephone | 480-232-1935
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | AHMED A KHAIRALLA
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Credential |
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Telephone | 480-232-1935
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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 | 454836
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License Number State | AZ
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