MEDICARE: MED GENERAL INC.

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	:	1801131446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED GENERAL INC.

Provider Business Mailing Address
First Line	:	417 ARDEN AVE
Second Line	:	SUITE 208
City	:	GLENDALE
State	:	CA
Zip	:	91203-4045
Country	:	US
Telephone Number	:	818-396-0907
Fax Number	:	818-500-0906

Provider Business Practice Location Address
First Line	:	417 ARDEN AVE
Second Line	:	SUITE 208
City	:	GLENDALE
State	:	CA
Zip	:	91203-4045
Country	:	US
Telephone Number	:	818-396-0907
Fax Number	:	818-500-0906

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. ANDREH GRIGORIAN
Credential	:
Telephone Number	:	818-396-0907

Provider Enumeration Date	:	12/08/2012
Last Update Date	:	11/13/2013

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