MEDICARE: SAFEWAY NON EMERGENCY MEDICAL TRANSPORT 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	:	1659054906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY NON EMERGENCY MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	8934 DOUBLETREE DR S
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9384
Country	:	US
Telephone Number	:	219-381-0442
Fax Number	:

Provider Business Practice Location Address
First Line	:	8934 DOUBLETREE DR S
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9384
Country	:	US
Telephone Number	:	219-381-0442
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ALGIA LEE JR.
Credential	:
Telephone Number	:	219-381-0442

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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