Organization
WAGON EXPRESS PROFESSIONAL TRANSPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEAH ANN LOWLEY (OWNER)
(505) 409-3612
Entity
Organization
Contact information
Practice address
BLACK ROCK ACRES, LOT 24, FORT DEFIANCE, AZ 86504
(928) 729-2786
Mailing address
PO BOX 1337, SAINT MICHAELS, AZ 86511-1337
(928) 729-2786
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
L-178166-8
AZ
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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