MEDICARE: NAZARETH ET TRANSPORTATION COMPANY 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	:	1578227377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZARETH ET TRANSPORTATION COMPANY LLC

Provider Business Mailing Address
First Line	:	3920 FREEPORT PL APT 11
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1264
Country	:	US
Telephone Number	:	202-867-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 FREEPORT PL APT 11
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1264
Country	:	US
Telephone Number	:	202-867-6677
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBOR ABEBE TEDBABE
Credential	:
Telephone Number	:	804-366-1118

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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