MEDICARE: RAVEN BANKS

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	:	1205528411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN BANKS

Provider Business Mailing Address
First Line	:	1235 13TH WAY
Second Line	:
City	:	PLEASANT GROVE
State	:	AL
Zip	:	35127-2451
Country	:	US
Telephone Number	:	205-210-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 13TH WAY
Second Line	:
City	:	PLEASANT GROVE
State	:	AL
Zip	:	35127-2451
Country	:	US
Telephone Number	:	205-210-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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Directions to “ RAVEN BANKS ” Practice Location

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