Provider Demographics
NPI:1669630182
Name:SUPERIOR MEDICAL TRANS, L.L.C
Entity Type:Organization
Organization Name:SUPERIOR MEDICAL TRANS, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELHASSAN TAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-423-8172
Mailing Address - Street 1:1203 W PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8693
Mailing Address - Country:US
Mailing Address - Phone:602-423-8172
Mailing Address - Fax:480-584-6562
Practice Address - Street 1:1203 W PARK CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8693
Practice Address - Country:US
Practice Address - Phone:602-423-8172
Practice Address - Fax:480-584-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126194Medicaid