MEDICARE: FOUR PEAKS 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)

General Provider Information

NPI Number	:	1952785560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR PEAKS MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	4746 W PALMAIRE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2742
Country	:	US
Telephone Number	:	602-387-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	4746 W PALMAIRE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2742
Country	:	US
Telephone Number	:	602-387-0830
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MS. SAMANTHA RAYE BEGAY
Credential	:
Telephone Number	:	602-387-0830

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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Directions to “FOUR PEAKS MEDICAL TRANSPORTATION ” Practice Location

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