Organization
TRICARE MEDICAL TRANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALI MAHMOUD (OWNER)
(602) 368-1707
Entity
Organization
Contact information
Practice address
1825 W OCOTILLO RD, STE #42, PHOENIX, AZ 85015-1257
(602) 368-7307
(602) 368-7308
Mailing address
1825 W OCOTILLO RD, STE #42, PHOENIX, AZ 85015-1257
(602) 368-7307
(602) 368-7308
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096611101
—
AZ
Enumeration date
05/24/2009
Last updated
05/24/2009
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