MEDICARE: 1TYME TRANSPORTATION SERVICES

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	:	1053752071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1TYME TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	7868 TANKARD DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3153
Country	:	US
Telephone Number	:	901-347-4154
Fax Number	:

Provider Business Practice Location Address
First Line	:	7868 TANKARD DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3153
Country	:	US
Telephone Number	:	901-347-4154
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LARRY C WILLIAMS
Credential	:
Telephone Number	:	901-438-6853

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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