Provider Demographics
NPI:1598073215
Name:CERTIFIED MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:CERTIFIED MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMICHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-930-8424
Mailing Address - Street 1:7000 N 16TH ST # 120-143
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5547
Mailing Address - Country:US
Mailing Address - Phone:602-930-8424
Mailing Address - Fax:
Practice Address - Street 1:7000 N 16TH ST # 120-143
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5547
Practice Address - Country:US
Practice Address - Phone:602-930-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISIT N CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)