MEDICARE: GOODWILL TRANSPORTATION SERVICES, 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	:	1629624176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL TRANSPORTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	5421 OLD POOLE RD STE 105
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	800-721-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 OLD POOLE RD STE 105
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	800-721-1092
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RAQUEL M THOMAS
Credential	:
Telephone Number	:	336-587-8797

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	10/02/2023

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