MEDICARE: NICKS MEDICAL TRANSPORT

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	:	1629924865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICKS MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	249 55TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-6737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 55TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-6737
Country	:	US
Telephone Number	:	202-937-7118
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEROME NICKS
Credential	:	NICKS
Telephone Number	:	202-937-7118

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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