MEDICARE: EXCELLENT TRANSPORTATION 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	:	1700442035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENT TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	623 ALTON RD
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3124
Country	:	US
Telephone Number	:	646-210-2901
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 ALTON RD
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3124
Country	:	US
Telephone Number	:	646-210-2901
Fax Number	:

Authorized Official
Title or Position	:	AMBR
Name	:	EDWIN MELENDEZ
Credential	:
Telephone Number	:	646-210-2901

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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