Provider Demographics
NPI:1588815781
Name:A FIRST CLASS SHUTTLE EXPRESS
Entity Type:Organization
Organization Name:A FIRST CLASS SHUTTLE EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-373-2527
Mailing Address - Street 1:2450 S 4TH AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:928-376-0205
Practice Address - Street 1:2450 S 4TH AVE STE 209
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8589
Practice Address - Country:US
Practice Address - Phone:928-373-2527
Practice Address - Fax:928-376-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)