MEDICARE: REVOLUTION TRANSPORTATION 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	172A00000X	Driver

General Provider Information

NPI Number	:	1083319412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLUTION TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	204 KINGSTON DR APT D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-2933
Country	:	US
Telephone Number	:	720-431-3093
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 KINGSTON DR APT D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-2933
Country	:	US
Telephone Number	:	720-431-3093
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AOCHI APUNGU
Credential	:	N/A
Telephone Number	:	720-431-3093

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/05/2023

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Directions to “REVOLUTION TRANSPORTATION LLC ” Practice Location

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