MEDICARE: CITY CAB L.L.C

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)	0176066	NC

General Provider Information

NPI Number	:	1275980534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY CAB L.L.C

Provider Business Mailing Address
First Line	:	3010 MONROE RD STE 108D
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7533
Country	:	US
Telephone Number	:	704-333-3327
Fax Number	:	704-333-4441

Provider Business Practice Location Address
First Line	:	3010 MONROE RD STE 108D
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7533
Country	:	US
Telephone Number	:	704-333-3327
Fax Number	:	704-333-4441

Authorized Official
Title or Position	:	OFFICE SUPERVISOR
Name	:	MISS NESA S TESFAY
Credential	:
Telephone Number	:	704-333-3327

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	05/17/2016

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