MEDICARE: MACK WAY TRANSPORTATION

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	:	1871199364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACK WAY TRANSPORTATION

Provider Business Mailing Address
First Line	:	521 W OAK ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95203-2815
Country	:	US
Telephone Number	:	415-571-3511
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W OAK ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95203-2815
Country	:	US
Telephone Number	:	415-571-3511
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. USTANO MCVEY
Credential	:
Telephone Number	:	415-571-3511

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/10/2020

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Directions to “MACK WAY TRANSPORTATION ” Practice Location

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