MEDICARE: N.E.M. TRANSPORT 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	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1144556283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N.E.M. TRANSPORT LLC

Provider Business Mailing Address
First Line	:	330 E MAPLE RD # 422
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6313
Country	:	US
Telephone Number	:	248-582-0200
Fax Number	:	888-202-1901

Provider Business Practice Location Address
First Line	:	25161 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-4240
Country	:	US
Telephone Number	:	248-582-0200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. SARAH VIDICAN
Credential	:
Telephone Number	:	586-944-9730

Provider Enumeration Date	:	10/24/2009
Last Update Date	:	10/24/2009

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