MEDICARE: VITAL LINK 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	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1487011185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL LINK TRANSPORT LLC

Provider Business Mailing Address
First Line	:	5246 JONES RD
Second Line	:	SUITE C
City	:	FOREST PARK
State	:	GA
Zip	:	30297-2609
Country	:	US
Telephone Number	:	404-500-1039
Fax Number	:	404-500-1039

Provider Business Practice Location Address
First Line	:	5246 JONES RD
Second Line	:	SUITE C
City	:	FOREST PARK
State	:	GA
Zip	:	30297-2609
Country	:	US
Telephone Number	:	404-500-1039
Fax Number	:	404-500-1039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EFFREN BIGHAM
Credential	:
Telephone Number	:	404-397-9171

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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