Provider Demographics
NPI:1457493199
Name:CENTRAL AZ TRANSPORTATION & TRAVEL
Entity type:Organization
Organization Name:CENTRAL AZ TRANSPORTATION & TRAVEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AL-FURQAN
Authorized Official - Last Name:AL-RAJAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-476-2111
Mailing Address - Street 1:7036 N 14TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5413
Mailing Address - Country:US
Mailing Address - Phone:602-476-2111
Mailing Address - Fax:602-476-2281
Practice Address - Street 1:7026 N 14TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5413
Practice Address - Country:US
Practice Address - Phone:602-476-2111
Practice Address - Fax:602-476-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ921868Medicaid