MEDICARE: SUNFLOWER TRANSPORTATION

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)

General Provider Information

NPI Number	:	1346555687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNFLOWER TRANSPORTATION

Provider Business Mailing Address
First Line	:	2814 W BELL RD STE 1415
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-7531
Country	:	US
Telephone Number	:	602-504-0506
Fax Number	:	602-504-0506

Provider Business Practice Location Address
First Line	:	2814 W. BELL RD, SUITE 1415
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053
Country	:	US
Telephone Number	:	602-504-0505
Fax Number	:	602-504-0506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. YAKOV YUSHUVAYEV
Credential	:
Telephone Number	:	602-504-0506

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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