Provider Demographics
NPI:1154564128
Name:MIDNIMO MEDICAL TRANSPORTATION CORP
Entity type:Organization
Organization Name:MIDNIMO MEDICAL TRANSPORTATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HALIMA
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:ABDIRAZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-273-7000
Mailing Address - Street 1:116 N LINDSAY RD
Mailing Address - Street 2:STE # 2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-9201
Mailing Address - Country:US
Mailing Address - Phone:602-273-7000
Mailing Address - Fax:602-273-7003
Practice Address - Street 1:116 N LINDSAY RD
Practice Address - Street 2:STE # 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-9201
Practice Address - Country:US
Practice Address - Phone:602-273-7000
Practice Address - Fax:602-273-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZADW9657343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ344355Medicaid