MEDICARE: COMMUNITY MED TRANS, INC

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609419258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MED TRANS, INC

Provider Business Mailing Address
First Line	:	4220 N COLLEGE AVE APT A
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-3863
Country	:	US
Telephone Number	:	559-612-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 N COLLEGE AVE APT A
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-3863
Country	:	US
Telephone Number	:	559-612-0220
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. YENESAW WASIHUN NEGATU
Credential	:
Telephone Number	:	559-612-0220

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/25/2019

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Directions to “COMMUNITY MED TRANS, INC ” Practice Location

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