MEDICARE: ULTRA MED 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	:	1558060665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA MED TRANS LLC

Provider Business Mailing Address
First Line	:	3834 W GOLDEN LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-3759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3834 W GOLDEN LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-3759
Country	:	US
Telephone Number	:	602-585-8767
Fax Number	:

Authorized Official
Title or Position	:	GM
Name	:	OMER ALABEID
Credential	:
Telephone Number	:	602-585-8767

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	05/02/2023

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Directions to “ULTRA MED TRANS LLC ” Practice Location

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