MEDICARE: SAFARI TRANS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1033423603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFARI TRANS INC

Provider Business Mailing Address
First Line	:	5633 N KENMORE AVE
Second Line	:	SUITE # 33
City	:	CHICAGO
State	:	IL
Zip	:	60660-4650
Country	:	US
Telephone Number	:	773-293-6845
Fax Number	:	773-293-7674

Provider Business Practice Location Address
First Line	:	5633 N KENMORE AVE
Second Line	:	SUITE # 33
City	:	CHICAGO
State	:	IL
Zip	:	60660-4622
Country	:	US
Telephone Number	:	773-293-6845
Fax Number	:	773-293-7674

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS HAPPY H MOSHA
Credential	:
Telephone Number	:	773-293-6845

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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