MEDICARE: ACE A1 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)

General Provider Information

NPI Number	:	1194364513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE A1 TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	PO BOX 43132
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-3132
Country	:	US
Telephone Number	:	904-514-6208
Fax Number	:	904-551-1669

Provider Business Practice Location Address
First Line	:	2120 WILSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-5454
Country	:	US
Telephone Number	:	904-514-6208
Fax Number	:	904-551-1669

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON BROWN BENT
Credential	:
Telephone Number	:	904-514-6208

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	01/02/2020

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