MEDICARE: DOWN RIVER X-PRESS LLC

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	343900000X	Non-emergency Medical Transport (VAN)		MI

General Provider Information

NPI Number	:	1053709212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWN RIVER X-PRESS LLC

Provider Business Mailing Address
First Line	:	146 CHARLES ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1114
Country	:	US
Telephone Number	:	313-458-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 CHARLES ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1114
Country	:	US
Telephone Number	:	313-458-2201
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAVON GRIFFIN
Credential	:
Telephone Number	:	313-978-8450

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	01/09/2015

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