Provider Demographics
NPI:1699905786
Name:ANGEL MEDICAL TRANS LLC
Entity type:Organization
Organization Name:ANGEL MEDICAL TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:YAHYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-754-9317
Mailing Address - Street 1:PO BOX 97523
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-7523
Mailing Address - Country:US
Mailing Address - Phone:602-754-9317
Mailing Address - Fax:602-595-0702
Practice Address - Street 1:1415 E APACHE BLVD APT 203
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5937
Practice Address - Country:US
Practice Address - Phone:602-754-9317
Practice Address - Fax:602-595-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ396377343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ396377OtherNON EMERGENCY MEDICAL TRANSPORTATION