Provider Demographics
NPI:1710169511
Name:IMATRANSLLC
Entity Type:Organization
Organization Name:IMATRANSLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-540-4288
Mailing Address - Street 1:8227 S 52ND LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2847
Mailing Address - Country:US
Mailing Address - Phone:602-237-7509
Mailing Address - Fax:602-237-7509
Practice Address - Street 1:8227S 52 LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:480-540-4288
Practice Address - Fax:602-237-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL13906769343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)