MEDICARE: WAYNE FENDERSON

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	:	1902442718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE FENDERSON

Provider Business Mailing Address
First Line	:	1383 REMOUNT RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3345
Country	:	US
Telephone Number	:	843-754-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1383 REMOUNT RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3345
Country	:	US
Telephone Number	:	843-754-7774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	11/27/2019

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Directions to “ WAYNE FENDERSON ” Practice Location

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