MEDICARE: U1ST MEDICAL TRANSPORTATION

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)	3041023	OH

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	:	1174844294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U1ST MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	1028 LORNABERRY LN
Second Line	:	SUITE 1
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3328
Country	:	US
Telephone Number	:	614-559-0616
Fax Number	:	614-866-2971

Provider Business Practice Location Address
First Line	:	1028 LORNABERRY LN
Second Line	:	SUITE 1
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3328
Country	:	US
Telephone Number	:	614-559-0616
Fax Number	:	614-866-2971

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. JAWANZA R MOORE
Credential	:
Telephone Number	:	16145590616

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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Directions to “U1ST MEDICAL TRANSPORTATION ” Practice Location

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