Provider Demographics
NPI:1649074709
Name:AGE MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:AGE MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GHOFRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:364-201-9906
Mailing Address - Street 1:1612 PLEASANT WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6320
Mailing Address - Country:US
Mailing Address - Phone:364-201-9906
Mailing Address - Fax:
Practice Address - Street 1:1612 PLEASANT WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6320
Practice Address - Country:US
Practice Address - Phone:364-201-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)