MEDICARE: CAREVAN 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)		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164675583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREVAN TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	N7294 TROPHY DR
Second Line	:
City	:	NEW LISBON
State	:	WI
Zip	:	53950-9561
Country	:	US
Telephone Number	:	608-547-1364
Fax Number	:

Provider Business Practice Location Address
First Line	:	N7294 TROPHY DR
Second Line	:
City	:	NEW LISBON
State	:	WI
Zip	:	53950-9561
Country	:	US
Telephone Number	:	608-547-1364
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	BIRGIT OLSON
Credential	:
Telephone Number	:	608-547-1364

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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