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NPI Code Detail

MEDICARE: FAIRWAY TRANSPORTATION LLC

MEDICARE: FAIRWAY 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
1343900000XNon-emergency Medical Transport (VAN)

General Provider Information

NPI Number : 1992278253
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAIRWAY TRANSPORTATION LLC
Provider Business Mailing Address
First Line : 6002 BAY HILL CT
Second Line :
City : ROMULUS
State : MI
Zip : 48174-6424
Country : US
Telephone Number : 734-494-0577
Fax Number : 734-892-2902
Provider Business Practice Location Address
First Line : 6002 BAY HILL CT
Second Line :
City : ROMULUS
State : MI
Zip : 48174-6424
Country : US
Telephone Number : 734-494-0577
Fax Number : 734-892-2902
Authorized Official
Title or Position : OWNER
Name : TAMIKA HOPKINS
Credential :
Telephone Number : 734-494-0577
Provider Enumeration Date : 01/09/2019
Last Update Date : 01/09/2019

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Directions to “FAIRWAY TRANSPORTATION LLC ” Practice Location

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