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NPI Code Detail

MEDICARE: DESERT BREEZE TRANSPORTATION, LLC

MEDICARE: DESERT BREEZE TRANSPORTATION, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1343900000XNon-emergency Medical Transport (VAN)D00045319AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1694617OTHERAZAHCCCS

General Provider Information

NPI Number : 1205219219
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESERT BREEZE TRANSPORTATION, LLC
Provider Business Mailing Address
First Line : 921 W CAMELBACK RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-2208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 921 W CAMELBACK RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-2208
Country : US
Telephone Number : 602-308-4502
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. SAMUEL L WRIGHT JR.
Credential :
Telephone Number : 602-308-4502
Provider Enumeration Date : 07/08/2015
Last Update Date : 07/08/2015

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Directions to “DESERT BREEZE TRANSPORTATION, LLC ” Practice Location

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