Provider Demographics
NPI:1225525363
Name:I GROUPS MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:I GROUPS MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-339-3138
Mailing Address - Street 1:5240 E BELLEVUE ST APT 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4842
Mailing Address - Country:US
Mailing Address - Phone:520-339-3138
Mailing Address - Fax:
Practice Address - Street 1:818 E MAIN ST TRLR 25
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2729
Practice Address - Country:US
Practice Address - Phone:520-339-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-403760-00-8343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)