1235462441 NPI number — MAGIC MISSILE TRANSPORTATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235462441 NPI number — MAGIC MISSILE TRANSPORTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAGIC MISSILE TRANSPORTATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MM TRANSPORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235462441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4354 N 82ND STREET
Provider Second Line Business Mailing Address:
STE201
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-381-4262
Provider Business Mailing Address Fax Number:
480-393-7399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4354 N 82ND ST
Provider Second Line Business Practice Location Address:
STE201
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-381-4262
Provider Business Practice Location Address Fax Number:
480-393-7399
Provider Enumeration Date:
09/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OSYATINSKY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
516-587-1386

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  265580123 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 344600000X , with the licence number: 265580123 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347B00000X , with the licence number: 265580123 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)