MEDICARE: DEDICATED CARING MEDICAL 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)	20161573887	NV

General Provider Information

NPI Number	:	1932643657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEDICATED CARING MEDICAL TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	6280 S VALLEY VIEW BLVD
Second Line	:	SUITE 723
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3809
Country	:	US
Telephone Number	:	702-405-9300
Fax Number	:	702-405-9933

Provider Business Practice Location Address
First Line	:	6280 S VALLEY VIEW BLVD
Second Line	:	SUITE 723
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3809
Country	:	US
Telephone Number	:	702-405-9300
Fax Number	:	702-405-9933

Authorized Official
Title or Position	:	CEO
Name	:	MR. DOUGLAS EDWARD KRONER
Credential	:
Telephone Number	:	702-405-9300

Provider Enumeration Date	:	12/14/2016
Last Update Date	:	12/14/2016

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