MEDICARE: COMTRANS

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515025	OTHER	AZ	AHCCCS ID NUMBER

General Provider Information

NPI Number	:	1306996848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMTRANS

Provider Business Mailing Address
First Line	:	2336 E MAGNOLIA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6819
Country	:	US
Telephone Number	:	602-231-0102
Fax Number	:	602-231-0015

Provider Business Practice Location Address
First Line	:	2336 E MAGNOLIA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6819
Country	:	US
Telephone Number	:	602-231-0102
Fax Number	:	602-231-0015

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JILL GILLESPIE
Credential	:	CPA
Telephone Number	:	602-231-0102

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	09/03/2010

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Directions to “COMTRANS ” Practice Location

Language	Start Address	Practice Location

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