MEDICARE: DESERT MOBILE 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)	BU-0025-10	AZ

General Provider Information

NPI Number	:	1376844332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT MOBILE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	PO BOX 133
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1802
Country	:	US
Telephone Number	:	480-987-6600
Fax Number	:	480-926-5377

Provider Business Practice Location Address
First Line	:	2476 W GOLDMINE MOUNTAIN CV
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-4757
Country	:	US
Telephone Number	:	480-987-6600
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING DIRECTOR
Name	:	SCOTT MCELHANEY
Credential	:	AZ AHCCCS #586611
Telephone Number	:	480-987-6600

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	06/24/2013

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