Provider Demographics
NPI:1063844165
Name:WHITE HORSE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:WHITE HORSE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WELDU
Authorized Official - Middle Name:MOSSAZGI
Authorized Official - Last Name:ARAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-358-7275
Mailing Address - Street 1:4347 W ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-6217
Mailing Address - Country:US
Mailing Address - Phone:480-358-7275
Mailing Address - Fax:
Practice Address - Street 1:4347 W ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:480-358-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ806190343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)