MEDICARE: FAST TRAC 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)

General Provider Information

NPI Number	:	1184986283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST TRAC TRANSPORTATION

Provider Business Mailing Address
First Line	:	20791 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-3549
Country	:	US
Telephone Number	:	760-686-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	20791 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-3549
Country	:	US
Telephone Number	:	760-686-1814
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAURICE HAWKINS
Credential	:
Telephone Number	:	760-686-1814

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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Directions to “FAST TRAC TRANSPORTATION ” Practice Location

Language	Start Address	Practice Location

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