MEDICARE: ROADRUNNER EXPRESS, 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)	N/A	CA

General Provider Information

NPI Number	:	1235442898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROADRUNNER EXPRESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 957
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94017-0957
Country	:	US
Telephone Number	:	800-608-1315
Fax Number	:	888-315-5419

Provider Business Practice Location Address
First Line	:	2345 BALBOA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-2912
Country	:	US
Telephone Number	:	800-608-1315
Fax Number	:	888-315-5419

Authorized Official
Title or Position	:	OWENER
Name	:	KHERLENCHIMEG BAASANDAMBA
Credential	:
Telephone Number	:	800-608-1315

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	10/23/2012

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