Provider Demographics
NPI:1740556711
Name:MO MEDTRANS, LLC
Entity Type:Organization
Organization Name:MO MEDTRANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MOAWIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELKARIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-392-3535
Mailing Address - Street 1:1811 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 295
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3001
Mailing Address - Country:US
Mailing Address - Phone:480-800-3130
Mailing Address - Fax:
Practice Address - Street 1:1811 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3001
Practice Address - Country:US
Practice Address - Phone:480-800-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ682737343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ682737OtherAHCCCS