Basic Information
| Provider Information | |||||||||
| NPI: | 1184342768 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAFE MEDICAL TRANSPORT CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8439 NOTTINGHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604592251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086794111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8439 NOTTINGHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604592251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086794111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2022 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | GHOULEH | ||||||||
| AuthorizedOfficialFirstName: | ANWAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7086794111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Emergency Medical Service Providers | Emergency Medical Technician, Basic | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.