MEDICARE: MEDI SET GO 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	:	1225854318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDI SET GO LLC

Provider Business Mailing Address
First Line	:	106 W OSBORN RD # 1123
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3909
Country	:	US
Telephone Number	:	314-898-3610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 W DESERT COVE AVE APT 4
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5749
Country	:	US
Telephone Number	:	314-898-3610
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	DAZHAWN DAVIS
Credential	:
Telephone Number	:	314-898-3610

Provider Enumeration Date	:	11/23/2024
Last Update Date	:	11/23/2024

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