MEDICARE: ASSISTED MEDICAL 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	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1538310537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED MEDICAL TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	2141 FOREST VIEW AVE
Second Line	:
City	:	HILLSBOROUGH
State	:	CA
Zip	:	94010-6169
Country	:	US
Telephone Number	:	650-464-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 FOREST VIEW AVE
Second Line	:
City	:	HILLSBOROUGH
State	:	CA
Zip	:	94010-6169
Country	:	US
Telephone Number	:	650-464-4477
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. SHEMA CHRISTINA SHERWIN
Credential	:
Telephone Number	:	650-678-8886

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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