Provider Demographics
NPI:1356033732
Name:SHALOM MEDICAL TRANSPORT
Entity type:Organization
Organization Name:SHALOM MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:SERIEUX
Authorized Official - Last Name:MUKIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:131-938-3941
Mailing Address - Street 1:4567 WYNDTREE DR APT 137
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-8604
Mailing Address - Country:US
Mailing Address - Phone:602-796-9726
Mailing Address - Fax:
Practice Address - Street 1:4567 WYNDTREE DR APT 137
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-8604
Practice Address - Country:US
Practice Address - Phone:602-796-9726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)