Provider Demographics
NPI:1629749080
Name:PHOENIX MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:PHOENIX MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIROLLOS
Authorized Official - Middle Name:MA
Authorized Official - Last Name:MEGALAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-473-3833
Mailing Address - Street 1:15442 FEATHERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2666
Mailing Address - Country:US
Mailing Address - Phone:914-473-3819
Mailing Address - Fax:
Practice Address - Street 1:15442 FEATHERCHASE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2666
Practice Address - Country:US
Practice Address - Phone:914-473-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)