MEDICARE: PRIME TIME TRANSPORTATION, INC.

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	343800000X	Secured Medical Transport (VAN)		NY
2	343900000X	Non-emergency Medical Transport (VAN)		NY
3	347B00000X	Bus
4	347B00000X	Bus		NY
5	347C00000X	Private Vehicle	B00296	NY
6	347C00000X	Private Vehicle		NY

General Provider Information

NPI Number	:	1366776254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME TIME TRANSPORTATION, INC.

Provider Business Mailing Address
First Line	:	2320 JACKSON AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4313
Country	:	US
Telephone Number	:	718-482-7970
Fax Number	:	718-482-6997

Provider Business Practice Location Address
First Line	:	2320 JACKSON AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4313
Country	:	US
Telephone Number	:	718-482-7970
Fax Number	:	718-482-6997

Authorized Official
Title or Position	:	SALES MANAGER
Name	:	MS. JUDY RICO
Credential	:
Telephone Number	:	718-482-7970

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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