MEDICARE: PENN MEDICAL LOGISTICS TRANSPORATION

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)	A20152466615	PA

General Provider Information

NPI Number	:	1376093757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN MEDICAL LOGISTICS TRANSPORATION

Provider Business Mailing Address
First Line	:	710 N HIGHLANDS DR
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17111-6912
Country	:	US
Telephone Number	:	717-592-0971
Fax Number	:	717-652-3461

Provider Business Practice Location Address
First Line	:	2515 N FRONT ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-1150
Country	:	US
Telephone Number	:	717-961-7743
Fax Number	:	717-896-6506

Authorized Official
Title or Position	:	MANAGER
Name	:	MOE HASSAN
Credential	:
Telephone Number	:	717-961-7743

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	08/30/2021

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