MEDICARE: MK VALLY 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	:	1962157107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK VALLY TRANSPORTATION

Provider Business Mailing Address
First Line	:	8608 S 2ND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-8405
Country	:	US
Telephone Number	:	623-229-3954
Fax Number	:

Provider Business Practice Location Address
First Line	:	8608 S 2ND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-8405
Country	:	US
Telephone Number	:	623-282-8955
Fax Number	:

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	MUGAHID ALI
Credential	:
Telephone Number	:	623-229-3954

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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