Provider Demographics
NPI:1841549789
Name:TRUCARE MED TRANS LLC.
Entity type:Organization
Organization Name:TRUCARE MED TRANS LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-435-6217
Mailing Address - Street 1:4836 E. WESTERN STAR BLVD.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1221
Mailing Address - Country:US
Mailing Address - Phone:602-435-6217
Mailing Address - Fax:
Practice Address - Street 1:4836 E. WESTERN STAR BLVD.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1221
Practice Address - Country:US
Practice Address - Phone:602-274-0774
Practice Address - Fax:480-588-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBMF38666343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000028178OtherPROCURE.AZ.GOV VENDOR: 000028178