MEDICARE: MED CARE TRANSPORTATION, 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)

General Provider Information

NPI Number	:	1518257203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED CARE TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	5079 OLD SUMMER RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4404
Country	:	US
Telephone Number	:	901-685-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	5079 OLD SUMMER RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4404
Country	:	US
Telephone Number	:	901-685-2212
Fax Number	:

Authorized Official
Title or Position	:	MANAGER AGENT
Name	:	JAMES E WILEY
Credential	:
Telephone Number	:	901-685-2212

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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