MEDICARE: MANAGED CARE TRANSPORATION 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	347E00000X	Transportation Broker
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1144591645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANAGED CARE TRANSPORATION LLC

Provider Business Mailing Address
First Line	:	1448 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1448 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4714
Country	:	US
Telephone Number	:	347-410-3497
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RAHAMIM SULTANA
Credential	:
Telephone Number	:	347-410-3497

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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