MEDICARE: QUALITY AND SAFETY TRANSPORT

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	:	1255955472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY AND SAFETY TRANSPORT

Provider Business Mailing Address
First Line	:	4515 SE 11TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8612
Country	:	US
Telephone Number	:	239-285-1343
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 SE 11TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8612
Country	:	US
Telephone Number	:	239-285-1343
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELLERY DOMINGUEZ
Credential	:
Telephone Number	:	239-285-1343

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	10/13/2020

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Directions to “QUALITY AND SAFETY TRANSPORT ” Practice Location

Language	Start Address	Practice Location

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