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	3416L0300X	Land Ambulance	56	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	590014619	OTHER		RR-MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F488	OTHER		FEP BCBS PROGRAM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8317179	OTHER		AETNA INDEMITY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	81-00017	OTHER		UNITED HEALTH CARE-EVERCARE
6	Z045	OTHER	MD	BCBS OF MARYLAND
7	54199	OTHER		AMERICAID
8	906502	OTHER		UNITED HEALTH CARE
9	215435	OTHER		ONENET
10	411001	OTHER		PRIME HEALTH
12	263906	OTHER	VA	ANTHEM BCBS
13	182909	OTHER		AETNA HMO
14	215435	OTHER		UHC-MAMSI
15	215435	OTHER		UHC-MDIPA
16	F488	OTHER		CAREFIRST

General Provider Information

NPI Number	:	1265761175
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	:	301-952-1280

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

Provider Enumeration Date	:	12/24/2009
Last Update Date	:	06/07/2013

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Directions to “AM-VAN INCORPORATED ” Practice Location

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