Provider Demographics
NPI:1073846101
Name:ARIZONA MED TRANS PLLC
Entity Type:Organization
Organization Name:ARIZONA MED TRANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARAMEDIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JED
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CLARIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-322-2105
Mailing Address - Street 1:17300 N DIAMOND BAR RD
Mailing Address - Street 2:P.O. BOX 68
Mailing Address - City:FORT THOMAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85536-0068
Mailing Address - Country:US
Mailing Address - Phone:928-322-2105
Mailing Address - Fax:
Practice Address - Street 1:17300 N DIAMOND BAR RD
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:AZ
Practice Address - Zip Code:85536-0068
Practice Address - Country:US
Practice Address - Phone:928-322-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport