Wagon Trail Professional Transport LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

L-1781666-8 Issued in AZ

Legal business name

WAGON TRAIL PROFESSIONAL TRANSPORT LLC

Practice address

24 Slick Rock Dr
Fort Defiance, AZ 86504

Phone

(928) 729-2944

Fax

(928) 729-2400

NPI assigned

Oct 2, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Forrest Lowley

Title

Owner

Phone

(928) 729-2944

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1124455357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3561",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-2944",
            "fax_number": "928-729-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 SLICK ROCK DR",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-2944",
            "fax_number": "928-729-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGON TRAIL PROFESSIONAL TRANSPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "LOWLEY",
        "authorized_official_first_name": "FORREST",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-729-2944"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "L-1781666-8",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L-1781666-8",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony S Vitelli, MD
• My-Ngoc Thi Vo, DMD
• Lyubov Vovk, RD
• Heather Waghelstein, ANP
• Wagon Express Professional Transport, LLC
• Tyrone Harold Walker, M.D.
• Melissa Marie Walters, OD
• Christopher Warren, DO
• Michael Warren
• Lucinda M Waseta, LMSW

• Non-emergency Medical Transport (VAN) in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Non-emergency Medical Transport (VAN) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.