Provider Demographics
NPI:1043601925
Name:E-GO MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:E-GO MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GAAFAR
Authorized Official - Middle Name:ABUEL GASIM
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-491-2648
Mailing Address - Street 1:3425 S PRIEST DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4470
Mailing Address - Country:US
Mailing Address - Phone:480-491-2648
Mailing Address - Fax:
Practice Address - Street 1:3425 S PRIEST DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4470
Practice Address - Country:US
Practice Address - Phone:480-491-2648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-1652117-0343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1396040697OtherNON EMERGENCY MEDICAL TRANSPORTATION