MEDICARE: ADVANCE WHEELCHAIR TRANSPORT SERVICE

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	:	1003389388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE WHEELCHAIR TRANSPORT SERVICE

Provider Business Mailing Address
First Line	:	83 HOLLYHOCK CT
Second Line	:
City	:	FLAT ROCK
State	:	NC
Zip	:	28731-9733
Country	:	US
Telephone Number	:	828-974-4647
Fax Number	:	828-696-4815

Provider Business Practice Location Address
First Line	:	83 HOLLYHOCK CT
Second Line	:
City	:	FLAT ROCK
State	:	NC
Zip	:	28731-9733
Country	:	US
Telephone Number	:	828-974-4647
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANTHONY BAXTER STRICKLAND
Credential	:
Telephone Number	:	828-974-4647

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	01/09/2019

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