MEDICARE: NICE AND CLEAN MEDICAL 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	:	1174027163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICE AND CLEAN MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	196 NW PROCTOR GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7622
Country	:	US
Telephone Number	:	850-363-9306
Fax Number	:	855-326-8575

Provider Business Practice Location Address
First Line	:	196 NW PROCTOR GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7622
Country	:	US
Telephone Number	:	850-363-9306
Fax Number	:	855-326-8575

Authorized Official
Title or Position	:	ADMIN
Name	:	LATASHA T GRAHAM
Credential	:
Telephone Number	:	386-754-8889

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	01/14/2026

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Directions to “NICE AND CLEAN MEDICAL SERVICES ” Practice Location

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