1699905786 NPI number — ANGEL MEDICAL TRANS LLC

Table of content: (NPI 1699905786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699905786 NPI number — ANGEL MEDICAL TRANS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL MEDICAL TRANS LLC
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:
Provider Other Organization Name Type Code:
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:
1699905786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97523
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85060-7523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-754-9317
Provider Business Mailing Address Fax Number:
602-595-0702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 E APACHE BLVD APT 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-754-9317
Provider Business Practice Location Address Fax Number:
602-595-0702
Provider Enumeration Date:
07/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YAHYA
Authorized Official First Name:
ABDALLA
Authorized Official Middle Name:
MOHAMED
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-754-9317

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  396377 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 396377 . This is a "NON EMERGENCY MEDICAL TRANSPORTATION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".