MEDICARE: CITY WIDE TRANSPORTATION

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	:	1558663252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY WIDE TRANSPORTATION

Provider Business Mailing Address
First Line	:	8914 N. 91ST AVENUE STE 110
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345
Country	:	US
Telephone Number	:	602-330-9527
Fax Number	:

Provider Business Practice Location Address
First Line	:	8914 N 91ST AVE STE 110
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-8390
Country	:	US
Telephone Number	:	602-330-9527
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YAKOV ROSS
Credential	:
Telephone Number	:	602-330-9527

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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Directions to “CITY WIDE TRANSPORTATION ” Practice Location

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