MEDICARE: REPUBLIK 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1457772600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REPUBLIK INC.

Provider Business Mailing Address
First Line	:	695 PYLANT ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3728
Country	:	US
Telephone Number	:	404-721-2324
Fax Number	:	404-393-4045

Provider Business Practice Location Address
First Line	:	695 PYLANT ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3728
Country	:	US
Telephone Number	:	404-721-2324
Fax Number	:	404-393-4045

Authorized Official
Title or Position	:	OPERATION MANAGER
Name	:	MR. CHRISTOPHER MARTELL TYLER
Credential	:	MBA
Telephone Number	:	404-721-2324

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	12/13/2013

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