MEDICARE: GOOD SHEPHERD TRANSPORT INC

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	:	1023361037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD TRANSPORT INC

Provider Business Mailing Address
First Line	:	4865 S YORK HWY
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-6568
Country	:	US
Telephone Number	:	931-265-8403
Fax Number	:	931-863-4989

Provider Business Practice Location Address
First Line	:	4865 S YORK HWY
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-6568
Country	:	US
Telephone Number	:	931-265-8403
Fax Number	:	931-863-4989

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID ROBBINS
Credential	:
Telephone Number	:	931-265-8403

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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