MEDICARE: ITDV NON EMERGENCY TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1184300485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITDV NON EMERGENCY TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	1872 SW 29TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1872 SW 29TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3826
Country	:	US
Telephone Number	:	954-348-5501
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TATYANA TSURKAN
Credential	:
Telephone Number	:	954-348-5501

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	06/22/2023

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