MEDICARE: AM-VAN INCORPORATED

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)	2275	MD
2	3416L0300X	Land Ambulance	56	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	590014619	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	182909	OTHER	MD	AETNA HMO
2	8100017	OTHER	MD	EVERCARE
3	906502	OTHER	MD	UNITED HEALTH CARE
4	F4880001	OTHER	MD	CAREFIRST BCBS OF MD/DC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	800296	OTHER	MD	DEPT OF LABOR
9	54199	OTHER	MD	AMERICAID
10	8317179	OTHER	MD	AETNA PPO
11	Z045AL	OTHER	MD	BCBS OF MD LOCAL PLAN
12	215435	OTHER	MD	MAMSI/ALLIANCE
13	263906	OTHER	MD	ANTHEM/TRIGON BCBS OF VA

General Provider Information

NPI Number	:	1235162520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AM-VAN INCORPORATED

Provider Business Mailing Address
First Line	:	1315 MARLBORO RD
Second Line	:
City	:	LOTHIAN
State	:	MD
Zip	:	20711-9541
Country	:	US
Telephone Number	:	301-952-1193
Fax Number	:	301-952-1280

Provider Business Practice Location Address
First Line	:	1315 MARLBORO RD
Second Line	:
City	:	LOTHIAN
State	:	MD
Zip	:	20711-9541
Country	:	US
Telephone Number	:	301-952-1193
Fax Number	:	301-952-0302

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. JAMES S FOWLER III
Credential	:
Telephone Number	:	301-952-1193

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/31/2013

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Directions to “AM-VAN INCORPORATED ” Practice Location

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