MEDICARE: UPLIFT TRANSPORT SERVICE 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	:	1932255734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFT TRANSPORT SERVICE INC

Provider Business Mailing Address
First Line	:	1410 CANADIEN GEESE CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7062
Country	:	US
Telephone Number	:
Fax Number	:	301-218-5810

Provider Business Practice Location Address
First Line	:	1410 CANADIEN GEESE CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7062
Country	:	US
Telephone Number	:	240-460-0895
Fax Number	:	301-218-5810

Authorized Official
Title or Position	:	OWNER
Name	:	LAURITA AJAGBA
Credential	:
Telephone Number	:	240-460-0895

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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