MEDICARE: MR. JERMAINE DAVID ADKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343800000X	Secured Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)
3	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1689952756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERMAINE DAVID ADKINS

Provider Business Mailing Address
First Line	:	7263 S COLES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2614
Country	:	US
Telephone Number	:	708-762-6162
Fax Number	:

Provider Business Practice Location Address
First Line	:	7263 S COLES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2614
Country	:	US
Telephone Number	:	708-762-6162
Fax Number	:

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

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	07/23/2011

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