Provider Demographics
NPI:1134463334
Name:GMT TRANSPORTATION PHOENIX, LLC
Entity Type:Organization
Organization Name:GMT TRANSPORTATION PHOENIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-948-4655
Mailing Address - Street 1:4147 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-1842
Mailing Address - Country:US
Mailing Address - Phone:480-948-4655
Mailing Address - Fax:623-258-4311
Practice Address - Street 1:4147 S 37TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-1842
Practice Address - Country:US
Practice Address - Phone:480-948-4655
Practice Address - Fax:623-258-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)