Provider Demographics
NPI:1265129324
Name:SUDAZONA MEDTRANS LLC
Entity type:Organization
Organization Name:SUDAZONA MEDTRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUBARAK
Authorized Official - Middle Name:MOHAMMED ISHAG
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-517-9056
Mailing Address - Street 1:2601 W CLAREMONT ST APT 2065
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-6252
Mailing Address - Country:US
Mailing Address - Phone:602-517-9056
Mailing Address - Fax:
Practice Address - Street 1:2601 W CLAREMONT ST APT 2065
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-6252
Practice Address - Country:US
Practice Address - Phone:602-517-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)