MEDICARE: HORIZON MEDICAL TRANSPORTATION, INC.

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)	2912095	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MTN01269F	OTHER	CA	MEDICAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1679748305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON MEDICAL TRANSPORTATION, INC.

Provider Business Mailing Address
First Line	:	9553 LOS COCHES CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6814
Country	:	US
Telephone Number	:	909-241-9956
Fax Number	:

Provider Business Practice Location Address
First Line	:	9553 LOS COCHES CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6814
Country	:	US
Telephone Number	:	909-241-9956
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MYRA L ALAGAO
Credential	:
Telephone Number	:	909-241-9956

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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