Provider Demographics
NPI:1326867383
Name:MAFBACKTRANS
Entity type:Organization
Organization Name:MAFBACKTRANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKULIJIRA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-668-3658
Mailing Address - Street 1:8630 W CORDES RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-3610
Mailing Address - Country:US
Mailing Address - Phone:314-668-3658
Mailing Address - Fax:314-668-3658
Practice Address - Street 1:8630 W CORDES RD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-3610
Practice Address - Country:US
Practice Address - Phone:314-668-3658
Practice Address - Fax:314-668-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)