MEDICARE: QUIAH GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343800000X	Secured Medical Transport (VAN)
2	347B00000X	Bus
3	347C00000X	Private Vehicle
4	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1316577208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUIAH GROUP, LLC

Provider Business Mailing Address
First Line	:	11317 ARISTOTLE DR APT 310
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-7494
Country	:	US
Telephone Number	:	202-427-5998
Fax Number	:

Provider Business Practice Location Address
First Line	:	11317 ARISTOTLE DR APT 310
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-7494
Country	:	US
Telephone Number	:	202-427-5998
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	ROSETTA K QUIAH
Credential	:
Telephone Number	:	202-427-5998

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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