MEDICARE: HA SAN

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	:	1508717547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA SAN

Provider Business Mailing Address
First Line	:	1201 FARWOOD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1211
Country	:	US
Telephone Number	:	260-564-1374
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 FARWOOD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1211
Country	:	US
Telephone Number	:	260-564-1374
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ HA SAN ” Practice Location

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