Provider Demographics
NPI:1205534542
Name:MEDWAYTRANSLLC@GMAIL.COM
Entity type:Organization
Organization Name:MEDWAYTRANSLLC@GMAIL.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHJOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-775-7777
Mailing Address - Street 1:598 N MCQUEEN RD APT K5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4775
Mailing Address - Country:US
Mailing Address - Phone:602-775-7777
Mailing Address - Fax:
Practice Address - Street 1:598 N MCQUEEN RD APT K5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4775
Practice Address - Country:US
Practice Address - Phone:602-775-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)