MEDICARE: E Z TRANSPORT 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)

General Provider Information

NPI Number	:	1447612452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E Z TRANSPORT LLC

Provider Business Mailing Address
First Line	:	2524 E SANDGATE AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-7981
Country	:	US
Telephone Number	:	208-602-1977
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 W FRANKLIN RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-2965
Country	:	US
Telephone Number	:	208-602-1977
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXIS FRANCO
Credential	:
Telephone Number	:	208-602-1977

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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