MEDICARE: ON-TIME TRANSPORTATION

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	SCDL007398105	SC
2	343900000X	Non-emergency Medical Transport (VAN)	SCDL007398105	SC

General Provider Information

NPI Number	:	1609141712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON-TIME TRANSPORTATION

Provider Business Mailing Address
First Line	:	3126 CARVERS BAY RD
Second Line	:
City	:	HEMINGWAY
State	:	SC
Zip	:	29554-4864
Country	:	US
Telephone Number	:	843-359-6584
Fax Number	:

Provider Business Practice Location Address
First Line	:	3126 CARVERS BAY RD
Second Line	:
City	:	HEMINGWAY
State	:	SC
Zip	:	29554-4864
Country	:	US
Telephone Number	:	843-359-6584
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. QUENTIN EARL MILLER SR.
Credential	:
Telephone Number	:	843-359-6584

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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Directions to “ON-TIME TRANSPORTATION ” Practice Location

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