MEDICARE: ADVANTRAN WHEELCHAIR TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)	9868492	NC

General Provider Information

NPI Number	:	1427385665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTRAN WHEELCHAIR TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	8511 DAVIS LAKE PKWY
Second Line	:	STE C6-262
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0536
Country	:	US
Telephone Number	:	704-529-2928
Fax Number	:	866-553-7489

Provider Business Practice Location Address
First Line	:	8511 DAVIS LAKE PKWY
Second Line	:	STE C6-262
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0536
Country	:	US
Telephone Number	:	704-529-2928
Fax Number	:	866-553-7489

Authorized Official
Title or Position	:	OPERATING MANAGER
Name	:	SHANNA WILEY
Credential	:
Telephone Number	:	704-529-2928

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/09/2009

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