MEDICARE: MEDGO 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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1639024557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDGO MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5422 W THUNDERBIRD RD STE 2
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5422 W THUNDERBIRD RD STE 2
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4717
Country	:	US
Telephone Number	:	619-576-4865
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VANG SENGALOUNE
Credential	:
Telephone Number	:	619-576-4865

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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