Provider Demographics
NPI:1104201144
Name:SOUTHERN ARIZONA TRANSPORTATION SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA TRANSPORTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-474-5177
Mailing Address - Street 1:1043 CIRCULO AVENTURA
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-1627
Mailing Address - Country:US
Mailing Address - Phone:520-474-5177
Mailing Address - Fax:
Practice Address - Street 1:1043 CIRCULO AVENTURA
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-1627
Practice Address - Country:US
Practice Address - Phone:520-474-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)