Provider Demographics
NPI:1376844332
Name:DESERT MOBILE TRANSPORT LLC
Entity Type:Organization
Organization Name:DESERT MOBILE TRANSPORT LLC
Other - Org Name:DESERT MOBILE TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:AZ AHCCCS #586611
Authorized Official - Phone:480-987-6600
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1802
Mailing Address - Country:US
Mailing Address - Phone:480-987-6600
Mailing Address - Fax:480-926-5377
Practice Address - Street 1:2476 W GOLDMINE MOUNTAIN CV
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4757
Practice Address - Country:US
Practice Address - Phone:480-987-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBU-0025-10343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)