MEDICARE: PHOENIX TRANSPORTATION 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)

General Provider Information

NPI Number	:	1427282912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	16430 DANE CT E
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-1302
Country	:	US
Telephone Number	:	262-373-0165
Fax Number	:	262-781-7645

Provider Business Practice Location Address
First Line	:	16430 DANE CT E
Second Line	:	16430 DANE CT EAST
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-1302
Country	:	US
Telephone Number	:	262-373-0165
Fax Number	:	262-781-7645

Authorized Official
Title or Position	:	CEO
Name	:	MRS. RUTH ALICE MCDOWELL
Credential	:
Telephone Number	:	262-373-0165

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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