MEDICARE: MUSTANG EXPRESS 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	343900000X	Non-emergency Medical Transport (VAN)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1386908887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSTANG EXPRESS LLC

Provider Business Mailing Address
First Line	:	5034 HERRING CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3473
Country	:	US
Telephone Number	:	727-264-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	5034 HERRING CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3473
Country	:	US
Telephone Number	:	727-264-7193
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. TONIE MARIE PROSE
Credential	:
Telephone Number	:	727-264-7193

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	06/28/2012

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Directions to “MUSTANG EXPRESS LLC ” Practice Location

Language	Start Address	Practice Location

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