Provider Demographics
NPI:1336914837
Name:SHALASH MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SHALASH MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-271-0330
Mailing Address - Street 1:1920 W KINFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8674
Mailing Address - Country:US
Mailing Address - Phone:614-271-0330
Mailing Address - Fax:
Practice Address - Street 1:6449 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2310
Practice Address - Country:US
Practice Address - Phone:614-271-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker