MEDICARE: EXPRESS2CARE 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	:	1588353346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS2CARE LLC

Provider Business Mailing Address
First Line	:	610 E ZACK ST STE 110-4263
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3972
Country	:	US
Telephone Number	:	813-624-9639
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 E ZACK ST STE 110-4263
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3972
Country	:	US
Telephone Number	:	813-624-9639
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED MEMBER (AMBR)
Name	:	JEFFERY WIGGINS
Credential	:
Telephone Number	:	813-624-9639

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	05/05/2023

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