Provider Demographics
NPI:1952785560
Name:FOUR PEAKS MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:FOUR PEAKS MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:BEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-387-0830
Mailing Address - Street 1:4746 W PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2742
Mailing Address - Country:US
Mailing Address - Phone:602-387-0830
Mailing Address - Fax:
Practice Address - Street 1:4746 W PALMAIRE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2742
Practice Address - Country:US
Practice Address - Phone:602-387-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)