MEDICARE: EAGLE MEDICAL TRANS, 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	:	1215791116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE MEDICAL TRANS, LLC

Provider Business Mailing Address
First Line	:	3321 CANDELARIA RD NE STE 317
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1969
Country	:	US
Telephone Number	:	602-394-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 CANDELARIA RD NE STE 317
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1969
Country	:	US
Telephone Number	:	602-394-2609
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARYAN AHMED
Credential	:
Telephone Number	:	602-394-2609

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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