MEDICARE: CITIZENS MEDICAL TRANSPORTATION, 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)	15-00119272	CA

General Provider Information

NPI Number	:	1336522101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS MEDICAL TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	10452 FOSSIL WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-1659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10452 FOSSIL WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-1659
Country	:	US
Telephone Number	:	209-272-9365
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAM HUYNH
Credential	:
Telephone Number	:	209-272-9365

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	12/08/2016

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