MEDICARE: AMANDA'S

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	:	1558354415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA'S

Provider Business Mailing Address
First Line	:	827 WYLEY AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2316
Country	:	US
Telephone Number	:	330-786-1826
Fax Number	:	330-786-1826

Provider Business Practice Location Address
First Line	:	827 WYLEY AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2316
Country	:	US
Telephone Number	:	330-786-1826
Fax Number	:	330-786-1826

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HAROLD HENRY FOX
Credential	:
Telephone Number	:	330-786-1826

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/30/2007

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Directions to “AMANDA'S ” Practice Location

Language	Start Address	Practice Location

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