Provider Demographics
NPI:1710096763
Name:AZ PATIENT TRANSPORT
Entity Type:Organization
Organization Name:AZ PATIENT TRANSPORT
Other - Org Name:STATE WIDE EXPRESS TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:HUGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-228-7754
Mailing Address - Street 1:P.O. BOX 4003
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366
Mailing Address - Country:US
Mailing Address - Phone:520-836-0303
Mailing Address - Fax:520-836-1114
Practice Address - Street 1:1790 N PINAL AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122
Practice Address - Country:US
Practice Address - Phone:520-836-0303
Practice Address - Fax:520-836-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ422832343900000X
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ422832OtherTRANSPORTATION
AZ422832Medicaid