MEDICARE: GOLDEN ARROWHEAD 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	:	1629825815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN ARROWHEAD MEDICAL TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	5946 FROND WAY
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2647
Country	:	US
Telephone Number	:	813-436-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	5946 FROND WAY
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2647
Country	:	US
Telephone Number	:	813-436-3199
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSHER CLAIRLYN GEORGE-ASHBY
Credential	:	RN
Telephone Number	:	813-436-3199

Provider Enumeration Date	:	05/04/2024
Last Update Date	:	05/10/2024

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