MEDICARE: EASY WAY MEDICAL TRANSPORTATION 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)

General Provider Information

NPI Number	:	1346761483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASY WAY MEDICAL TRANSPORTATION SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 724051
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31139-1051
Country	:	US
Telephone Number	:	757-214-7131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 WYOMING AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-4549
Country	:	US
Telephone Number	:	757-214-7131
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADEKOLA OSUNLAKIN
Credential	:
Telephone Number	:	757-214-7137

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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