Provider Demographics
NPI:1609438027
Name:DESERT TRANS LLC
Entity Type:Organization
Organization Name:DESERT TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIWALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-802-9437
Mailing Address - Street 1:2406 S 24TH ST STE E107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-6858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 MARQUETTE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-5340
Practice Address - Country:US
Practice Address - Phone:602-802-9437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)