MEDICARE: SUNRISE 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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881924660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE TRANSPORTATION LLC.

Provider Business Mailing Address
First Line	:	225 FAIRWAY BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2071
Country	:	US
Telephone Number	:	614-735-8823
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 FAIRWAY BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2071
Country	:	US
Telephone Number	:	614-735-8823
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ASTEWALECH WASSIHUN
Credential	:
Telephone Number	:	614-735-8823

Provider Enumeration Date	:	12/30/2009
Last Update Date	:	12/30/2009

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