MEDICARE: METROPOLITAN COMMUNITY DEVELOPMENT CORPORATION, INC.

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)	1916971	WV

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	:	1215215496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN COMMUNITY DEVELOPMENT CORPORATION, INC.

Provider Business Mailing Address
First Line	:	205 DONNALLY ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1122
Country	:	US
Telephone Number	:	304-342-4775
Fax Number	:	304-342-4799

Provider Business Practice Location Address
First Line	:	205 DONNALLY ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1122
Country	:	US
Telephone Number	:	304-342-4775
Fax Number	:	304-342-4799

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PASTOR DARIN G FREEMAN SR.
Credential	:	PASTOR
Telephone Number	:	304-342-4775

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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