MEDICARE: AFFORDABLE MEDICAL 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)	73881	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	:	1326341173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	9026 ASHTON POINTE BLVD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2542
Country	:	US
Telephone Number	:	260-609-2605
Fax Number	:

Provider Business Practice Location Address
First Line	:	9026 ASHTON POINTE BLVD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2542
Country	:	US
Telephone Number	:	260-609-2605
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MONICA SUE REYES
Credential	:
Telephone Number	:	260-609-2605

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/22/2010

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Directions to “AFFORDABLE MEDICAL TRANSPORT ” Practice Location

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