MEDICARE: ALTA MODA MEDICAL SERVICES LC

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)

General Provider Information

NPI Number	:	1093136780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA MODA MEDICAL SERVICES LC

Provider Business Mailing Address
First Line	:	224 6TH AVE SW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-2128
Country	:	US
Telephone Number	:	319-310-9128
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 J AVE NE
Second Line	:	SUITE 200
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4520
Country	:	US
Telephone Number	:	319-365-1382
Fax Number	:	319-365-1429

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ABDIAZIZ N HAJIABDIRAHMAN
Credential	:
Telephone Number	:	319-310-9128

Provider Enumeration Date	:	12/23/2013
Last Update Date	:	02/17/2014

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