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

General Provider Information

NPI Number	:	1306159793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAAMO MEDICAL TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	4040 E MCDOWELL RD
Second Line	:	STE# 405
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4414
Country	:	US
Telephone Number	:	602-679-0020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD
Second Line	:	STE# 405
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4414
Country	:	US
Telephone Number	:	602-679-0020
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. BASHEIR W ELMI
Credential	:
Telephone Number	:	602-679-0020

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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