MEDICARE: BLUE CHIP TRANSIT

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)	BL2016-00016	AR

General Provider Information

NPI Number	:	1932555034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE CHIP TRANSIT

Provider Business Mailing Address
First Line	:	11028 BODARC LN
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-9743
Country	:	US
Telephone Number	:	870-329-4067
Fax Number	:

Provider Business Practice Location Address
First Line	:	11028 BODARC LN
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-9743
Country	:	US
Telephone Number	:	870-329-4067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFERY LLOYD WILLIAMS JR.
Credential	:
Telephone Number	:	870-329-4067

Provider Enumeration Date	:	05/06/2016
Last Update Date	:	05/06/2016

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