Provider Demographics
NPI:1366726499
Name:GROUP NON EMERGENCY MEDICAL TRANESPORT
Entity type:Organization
Organization Name:GROUP NON EMERGENCY MEDICAL TRANESPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEMACHU
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-4467
Mailing Address - Street 1:7204 S 13TH ST
Mailing Address - Street 2:7204 S 13TH ST
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5688
Mailing Address - Country:US
Mailing Address - Phone:480-567-4467
Mailing Address - Fax:602-714-5244
Practice Address - Street 1:7204 S 13 ST
Practice Address - Street 2:7204 S 13 ST
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5688
Practice Address - Country:US
Practice Address - Phone:480-567-4467
Practice Address - Fax:602-714-5244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROUP NON EMERGENCY MEDICAL TRANESPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341600000X341600000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance