MEDICARE: SUDAMED 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	:	1780958959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUDAMED MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2911 S PALM SPRINGS DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-2102
Country	:	US
Telephone Number	:	520-310-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 S PALM SPRINGS DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-2102
Country	:	US
Telephone Number	:	520-310-6688
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SALAH ABDALLA
Credential	:
Telephone Number	:	520-310-6688

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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