MEDICARE: KIWANIS RUCKER

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)
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1649196114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIWANIS RUCKER

Provider Business Mailing Address
First Line	:	4909 ALABAMA AVE # 1033
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3449
Country	:	US
Telephone Number	:	615-752-7224
Fax Number	:

Provider Business Practice Location Address
First Line	:	4909 ALABAMA AVE # 1033
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3449
Country	:	US
Telephone Number	:	615-752-7224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2026
Last Update Date	:	06/27/2026

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Directions to “ KIWANIS RUCKER ” Practice Location

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