MEDICARE: 17TH DISTRICT INC.

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	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1245969203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	17TH DISTRICT INC.

Provider Business Mailing Address
First Line	:	13547 VENTURA BLVD # 232
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-3825
Country	:	US
Telephone Number	:	323-517-3178
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 CAHUENGA BLVD W
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1366
Country	:	US
Telephone Number	:	323-517-3178
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RASHAD SCROGGINS
Credential	:
Telephone Number	:	323-517-3178

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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Directions to “17TH DISTRICT INC. ” Practice Location

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