Provider Demographics
NPI:1700381910
Name:EAGLE EYE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:EAGLE EYE MEDICAL TRANSPORTATION
Other - Org Name:EAGLE EYE MEDICAL TRANSPORTATION, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-699-6393
Mailing Address - Street 1:2107 W BROADWAY RD APT 235
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-1057
Mailing Address - Country:US
Mailing Address - Phone:602-699-6393
Mailing Address - Fax:
Practice Address - Street 1:2107 W BROADWAY RD APT 235
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1057
Practice Address - Country:US
Practice Address - Phone:602-699-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)