1457664252 NPI number — VALLEY CARE MEDICAL TRANSPORTATION

Table of content: (NPI 1457664252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457664252 NPI number — VALLEY CARE MEDICAL TRANSPORTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CARE MEDICAL 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:
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:
1457664252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2559 W TAMARISK AVE
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:
85041-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-697-0429
Provider Business Mailing Address Fax Number:
602-437-0109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 S 48TH ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-437-0106
Provider Business Practice Location Address Fax Number:
602-437-0109
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ABDELRAHMAN
Authorized Official First Name:
ABDELRAHIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-697-0429

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  478952 , 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: 478952 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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