MEDICARE: EXECUTIVE EXPRESS SERVICES 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	347C00000X	Private Vehicle		FL

General Provider Information

NPI Number	:	1386154565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXECUTIVE EXPRESS SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 650372
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32965-0372
Country	:	US
Telephone Number	:	772-559-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 WOODLAND CIR APT 208
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-2037
Country	:	US
Telephone Number	:	772-559-7217
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TANJA WRIGHT
Credential	:
Telephone Number	:	772-559-7217

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	10/02/2017

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Directions to “EXECUTIVE EXPRESS SERVICES LLC ” Practice Location

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