MEDICARE: CROSS NON-EMERGENCY MEDICAL 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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1124526991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS NON-EMERGENCY MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	7027 S 58TH AVE
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2266
Country	:	US
Telephone Number	:	480-277-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 WASHINGTON AVE
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-2073
Country	:	US
Telephone Number	:	480-277-1016
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	FITSUM ABREHA SR.
Credential	:	OWNER
Telephone Number	:	480-277-1016

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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