MEDICARE: JUDY'S TEAM

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	:	1174088355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDY'S TEAM

Provider Business Mailing Address
First Line	:	4214 CAMPBELLS RUN RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-1306
Country	:	US
Telephone Number	:	412-279-9205
Fax Number	:	412-279-9202

Provider Business Practice Location Address
First Line	:	4214 CAMPBELLS RUN RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-1306
Country	:	US
Telephone Number	:	412-279-9205
Fax Number	:	412-279-9202

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK RICHARD SUEHR
Credential	:	CEO
Telephone Number	:	412-901-0772

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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