Provider Demographics
NPI:1699023952
Name:TARA TRANS
Entity Type:Organization
Organization Name:TARA TRANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GALALELDIN
Authorized Official - Middle Name:EISSA
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-228-4098
Mailing Address - Street 1:8237 E MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6217
Mailing Address - Country:US
Mailing Address - Phone:480-228-4098
Mailing Address - Fax:480-323-2374
Practice Address - Street 1:8237 E MCDONALD DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6217
Practice Address - Country:US
Practice Address - Phone:480-228-4098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL17496308343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ703516Medicaid
AZ703516OtherINDIAN HEALTH SERVICE (IHS)
AZ703516Medicaid