MEDICARE: AMANAH MEDICAL TRANSPORT 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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1215620869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANAH MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	6615 N 17TH AVE APT 25B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1309
Country	:	US
Telephone Number	:	619-642-5192
Fax Number	:

Provider Business Practice Location Address
First Line	:	6615 N 17TH AVE APT 25B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1309
Country	:	US
Telephone Number	:	619-642-5192
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	SHAMSELDIN ABDELAZIZ
Credential	:
Telephone Number	:	619-642-5192

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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