MEDICARE: ROYAL LIMO SERVICE

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)	46400	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326118894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL LIMO SERVICE

Provider Business Mailing Address
First Line	:	4925 AVONDALE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3104
Country	:	US
Telephone Number	:	260-458-9530
Fax Number	:	260-458-9530

Provider Business Practice Location Address
First Line	:	4925 AVONDALE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3104
Country	:	US
Telephone Number	:	260-458-9530
Fax Number	:	260-458-9530

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES S SANDERS SR.
Credential	:
Telephone Number	:	260-458-9530

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/23/2008

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Directions to “ROYAL LIMO SERVICE ” Practice Location

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