MEDICARE: PRIMETIME MEDICAL 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	:	1588461370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMETIME MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5849 TERNES ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2009
Country	:	US
Telephone Number	:	313-736-2577
Fax Number	:

Provider Business Practice Location Address
First Line	:	5849 TERNES ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2009
Country	:	US
Telephone Number	:	313-736-2577
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARWAN SAAD ALGAHMI
Credential	:
Telephone Number	:	313-736-2577

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	02/27/2025

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