MEDICARE: EMPIRE TRANSPORTATION, 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	:	1235852195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	6045 ATLANTIC BLVD STE 219
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30071-1327
Country	:	US
Telephone Number	:	404-663-2721
Fax Number	:	770-733-1307

Provider Business Practice Location Address
First Line	:	950 HERRINGTON RD STE H
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-7217
Country	:	US
Telephone Number	:	404-482-3114
Fax Number	:	770-733-1307

Authorized Official
Title or Position	:	MANAGING MBR- OWNER
Name	:	MRS. GARINA MARTINEZ SMITH
Credential	:
Telephone Number	:	404-663-2721

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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