Provider Demographics
NPI:1023534260
Name:YUMA MEDICAL TRANSPORT
Entity type:Organization
Organization Name:YUMA MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:KIMBALL
Authorized Official - Last Name:HUGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-228-7508
Mailing Address - Street 1:PO BOX 4003
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2405
Mailing Address - Country:US
Mailing Address - Phone:928-920-4935
Mailing Address - Fax:928-433-0087
Practice Address - Street 1:281 W 24TH ST STE 139
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8500
Practice Address - Country:US
Practice Address - Phone:928-920-4935
Practice Address - Fax:928-433-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ078330Medicaid