MEDICARE: PROFESSIONAL TAXI & SHUTTLE SERVICES

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	344600000X	Taxi	35456342	NC
2	347B00000X	Bus	35456342	NC
3	347E00000X	Transportation Broker	35456342	NC
4	343900000X	Non-emergency Medical Transport (VAN)	35456342	NC

General Provider Information

NPI Number	:	1619289378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL TAXI & SHUTTLE SERVICES

Provider Business Mailing Address
First Line	:	1205 N PINE ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-4711
Country	:	US
Telephone Number	:	910-416-0458
Fax Number	:	888-268-3284

Provider Business Practice Location Address
First Line	:	1205 N PINE ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-4711
Country	:	US
Telephone Number	:	910-416-0458
Fax Number	:	888-268-3284

Authorized Official
Title or Position	:	OWNER
Name	:	MARY VIRGINIA DARBY
Credential	:
Telephone Number	:	910-416-0458

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	07/10/2010

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