MEDICARE: COACH TRANSPOT 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	:	1295229888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACH TRANSPOT LLC

Provider Business Mailing Address
First Line	:	8707 PLAYGROUND CT
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-2378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8707 PLAYGROUND CT
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-2378
Country	:	US
Telephone Number	:	804-562-1942
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PALAE SMITH
Credential	:
Telephone Number	:	804-562-1942

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	06/18/2018

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Directions to “COACH TRANSPOT LLC ” Practice Location

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