MEDICARE: CHC901 LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3416A0800X	Air Ambulance
2	3416L0300X	Land Ambulance
3	343900000X	Non-emergency Medical Transport (VAN)
4	341600000X	Ambulance

General Provider Information

NPI Number	:	1326681594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHC901 LLC

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:
City	:	BRUNSWICK
State	:	TN
Zip	:	38014-0250
Country	:	US
Telephone Number	:	901-425-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2565 HORIZON LAKE DR STE 110
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8113
Country	:	US
Telephone Number	:	901-321-0911
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	MR. MICHAEL W NOLEN JR.
Credential	:
Telephone Number	:	901-275-5131

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	05/06/2020

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