Provider Demographics
NPI:1861131435
Name:ESTHMUND MED TRANSPORTATION LLC
Entity type:Organization
Organization Name:ESTHMUND MED TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGED
Authorized Official - Prefix:
Authorized Official - First Name:AWURAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-632-3536
Mailing Address - Street 1:6604 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7630
Mailing Address - Country:US
Mailing Address - Phone:614-632-3536
Mailing Address - Fax:
Practice Address - Street 1:6604 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7630
Practice Address - Country:US
Practice Address - Phone:614-632-3536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)