MEDICARE: SIGNATURE TRANSPORTATION SERVICES, 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	:	1245631969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE TRANSPORTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	755 W BIG BEAVER RD
Second Line	:	SUITE #1111
City	:	TROY
State	:	MI
Zip	:	48084-4900
Country	:	US
Telephone Number	:	248-825-4606
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 W BIG BEAVER RD
Second Line	:	SUITE #1111
City	:	TROY
State	:	MI
Zip	:	48084-4900
Country	:	US
Telephone Number	:	248-825-4606
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. MENA VICTOR SHEHATA
Credential	:
Telephone Number	:	734-273-9256

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	09/12/2014

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