MEDICARE: NET RUNS 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	:	1679170229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NET RUNS LLC

Provider Business Mailing Address
First Line	:	2703 BEVERLY P WASHINGTON ST
Second Line	:
City	:	PRICHARD
State	:	AL
Zip	:	36613-3449
Country	:	US
Telephone Number	:	251-458-3190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 BEVERLY P WASHINGTON ST
Second Line	:
City	:	PRICHARD
State	:	AL
Zip	:	36613-3449
Country	:	US
Telephone Number	:	251-458-3190
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATAVIA NICOLE RANDOLPH
Credential	:
Telephone Number	:	251-458-3190

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	10/07/2020

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Directions to “NET RUNS LLC ” Practice Location

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