Provider Demographics
NPI:1417217852
Name:SUNTRANS
Entity Type:Organization
Organization Name:SUNTRANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GASSMELSYED
Authorized Official - Suffix:
Authorized Official - Credentials:12/26/1975
Authorized Official - Phone:602-503-5848
Mailing Address - Street 1:6744 E MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3246
Mailing Address - Country:US
Mailing Address - Phone:602-503-5848
Mailing Address - Fax:
Practice Address - Street 1:6744 E MORELAND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3246
Practice Address - Country:US
Practice Address - Phone:602-503-5848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNTRANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-18
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ591567343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)