=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912278748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A CLASS 1-S TRANSPORTATION CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2012
-----------------------------------------------------
Last Update Date | 01/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 MOUNTAIN AVE
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-6229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-381-1337
-----------------------------------------------------
Fax | 888-740-6885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56 MONRO ST
-----------------------------------------------------
City | WALDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12586-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-381-1337
-----------------------------------------------------
Fax | 888-740-6885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROLAND L SMITH JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-381-1337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 12970LV
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------