MEDICARE: GT SUMMIT GROUP 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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2089504	OTHER	AK	AK LICENSE #

General Provider Information

NPI Number	:	1467099192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GT SUMMIT GROUP LLC

Provider Business Mailing Address
First Line	:	8600 WILLIWA AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-4251
Country	:	US
Telephone Number	:	907-575-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 WILLIWA AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-4251
Country	:	US
Telephone Number	:	907-575-2222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HARLAN ROBERT GONZALES
Credential	:
Telephone Number	:	917-582-5952

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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Directions to “GT SUMMIT GROUP LLC ” Practice Location

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