Provider Demographics
NPI:1659407864
Name:ARIZONA MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:ARIZONA MEDICAL TRANSPORT, LLC
Other - Org Name:ARIZONA MEDICAL TRANSIT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:BERTHA
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-792-0944
Mailing Address - Street 1:20 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7752
Mailing Address - Country:US
Mailing Address - Phone:520-792-0944
Mailing Address - Fax:520-882-7229
Practice Address - Street 1:20 E 2ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7752
Practice Address - Country:US
Practice Address - Phone:520-792-0944
Practice Address - Fax:520-882-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ174156OtherAHCCCS PROVIDER NUMBER