MEDICARE: MR. MICHAEL WIMBERLY

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	:	1457880593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WIMBERLY

Provider Business Mailing Address
First Line	:	2258 ROANOKE SPRINGS DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-6314
Country	:	US
Telephone Number	:	727-259-3848
Fax Number	:	813-922-6702

Provider Business Practice Location Address
First Line	:	2258 ROANOKE SPRINGS DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-6314
Country	:	US
Telephone Number	:	727-259-3848
Fax Number	:	813-922-6702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2017
Last Update Date	:	07/21/2022

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Directions to “ MR. MICHAEL WIMBERLY ” Practice Location

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