MEDICARE: PHOENIX MEDICAL TRANSPORTATION 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	:	1629749080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	15442 FEATHERCHASE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2666
Country	:	US
Telephone Number	:	914-473-3819
Fax Number	:

Provider Business Practice Location Address
First Line	:	15442 FEATHERCHASE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2666
Country	:	US
Telephone Number	:	914-473-3819
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KIROLLOS MA MEGALAA
Credential	:
Telephone Number	:	914-473-3833

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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