MEDICARE: ELITE MEDICAL TRANSIT PROFESSIONAL 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	:	1568928463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICAL TRANSIT PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	4209 GAULT PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-8006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 GAULT PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-8006
Country	:	US
Telephone Number	:	240-779-7113
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CANDICE M TIMS
Credential	:
Telephone Number	:	240-779-7113

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	02/20/2019

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