MEDICARE: TAMIKA'S TRANSPORTATION SERVICE 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	:	1457933970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMIKA'S TRANSPORTATION SERVICE LLC

Provider Business Mailing Address
First Line	:	5602 TROY VILLA BLVD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2646
Country	:	US
Telephone Number	:	937-270-1664
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 TROY VILLA BLVD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2646
Country	:	US
Telephone Number	:	937-270-1664
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMIKA WOOD
Credential	:
Telephone Number	:	937-270-1664

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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