Organization
ARIZONA ROAD-RUNNER SHUTTLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN DEAN PAYNE (OWNER)
(928) 486-5844
Entity
Organization
Contact information
Practice address
2169 SWANSON AVE, UNIT 10, LAKE HAVASU CITY, AZ 86403-6878
(928) 854-9333
(928) 453-9234
Mailing address
2169 SWANSON AVE, UNIT 10, LAKE HAVASU CITY, AZ 86403-6878
(928) 854-9333
(928) 453-9234
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098350
AHCCCS
AZ
Enumeration date
02/22/2007
Last updated
08/22/2020
Update your record
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