MEDICARE: HEAL MEDICAL TRANSPORTATION

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)	144894	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	144894	OTHER	AZ	PROVIDER NUMBER

General Provider Information

NPI Number	:	1851585251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAL MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	5220 W. NORTHERN AVE.
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301
Country	:	US
Telephone Number	:	602-315-8884
Fax Number	:	623-249-5444

Provider Business Practice Location Address
First Line	:	5220 W NORTHERN AVE APT 209
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1410
Country	:	US
Telephone Number	:	602-315-8884
Fax Number	:	623-249-5444

Authorized Official
Title or Position	:	OWNER
Name	:	FAISAL H ELHASSAN
Credential	:
Telephone Number	:	602-315-8884

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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Directions to “HEAL MEDICAL TRANSPORTATION ” Practice Location

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