MEDICARE: GLORY TRANSPORTATION & SERVICES 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	344600000X	Taxi

General Provider Information

NPI Number	:	1528776283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORY TRANSPORTATION & SERVICES LLC

Provider Business Mailing Address
First Line	:	103 EXECUTIVE CIR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7134
Country	:	US
Telephone Number	:	540-623-1028
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 EXECUTIVE CIR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7134
Country	:	US
Telephone Number	:	540-623-1028
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALIMAMY S BUNDU
Credential	:
Telephone Number	:	540-623-1028

Provider Enumeration Date	:	11/11/2022
Last Update Date	:	11/11/2022

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