WAGON TRAIL PROFESSIONAL TRANSPORT LLC NPI 1124455357

NPI Information

  • NPI: 1124455357
  • Provider Name: WAGON TRAIL PROFESSIONAL TRANSPORT LLC
  • Classification: Non-emergency Medical Transport (VAN) - 343900000X
  • Entity Type: Organization
  • Address: 24 SLICK ROCK DR
    FORT DEFIANCE, AZ
    ZIP 86504
  • Phone: (928) 729-2944

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NPI Details

WAGON TRAIL PROFESSIONAL TRANSPORT LLC is a non emergency medical transport van in Fort Defiance, AZ. The provider is a land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. WAGON TRAIL PROFESSIONAL TRANSPORT LLC NPI is 1124455357. The provider is registered as an organization entity type.

The provider's business location address is:

24 SLICK ROCK DR
FORT DEFIANCE, AZ
ZIP 86504
Phone: (928) 729-2944
Fax: (928) 729-2400

The provider's authorized official is Forrest Lowley .
The authorized official title is Owner and has the following contact phone number (928) 729-2944.

The enumeration date for this NPI number is 10/2/2013 and was last updated on 10/2/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1343900000XNon-emergency Medical Transport (VAN)L-1781666-8ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1L-1781666-8MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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