MEDICARE: LIFELINE TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343800000X	Secured Medical Transport (VAN)
2	347C00000X	Private Vehicle
3	347E00000X	Transportation Broker
4	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1225481617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6877 1/2 AMHERST ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3074
Country	:	US
Telephone Number	:	619-552-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	6877 1/2 AMHERST ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3074
Country	:	US
Telephone Number	:	619-552-5552
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DHAHA NUR
Credential	:
Telephone Number	:	619-552-5552

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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Directions to “LIFELINE TRANSPORTATION LLC ” Practice Location

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