MEDICARE: MCEWAN MEDICAL 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	:	1528435641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCEWAN MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6041 VILLAGE BEND DR
Second Line	:	#1105
City	:	DALLAS
State	:	TX
Zip	:	75206-3600
Country	:	US
Telephone Number	:	214-288-2810
Fax Number	:	469-283-0603

Provider Business Practice Location Address
First Line	:	6041 VILLAGE BEND DR
Second Line	:	#1105
City	:	DALLAS
State	:	TX
Zip	:	75206-3600
Country	:	US
Telephone Number	:	214-288-2810
Fax Number	:	469-283-0603

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT MCEWAN
Credential	:
Telephone Number	:	214-288-2810

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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