Provider Demographics
NPI:1093225591
Name:HEALTHLIFT MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:HEALTHLIFT MEDICAL TRANSPORTATION, INC.
Other - Org Name:HEALTHLIFT MEDICAL TRANSPORTATION COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:1606 W WHISPERING WIND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-1322
Mailing Address - Country:US
Mailing Address - Phone:623-233-8800
Mailing Address - Fax:623-581-1110
Practice Address - Street 1:2656 S LOOP W STE 360
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:623-233-8800
Practice Address - Fax:623-581-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378977801Medicaid