MEDICARE: SOUTH GEORGIA TRANSPORTATION COMPANY

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	:	1154176352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH GEORGIA TRANSPORTATION COMPANY

Provider Business Mailing Address
First Line	:	3318 EUCLID HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3318 EUCLID HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1822
Country	:	US
Telephone Number	:	216-355-7789
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH LAMAR
Credential	:
Telephone Number	:	216-355-7789

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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