MEDICARE: A WAY 2 TRAVEL INCORPORATED

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	:	1720502164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A WAY 2 TRAVEL INCORPORATED

Provider Business Mailing Address
First Line	:	15814 JEFFERSON DAVIS HWY
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15814 JEFFERSON DAVIS HWY
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5202
Country	:	US
Telephone Number	:	804-451-1455
Fax Number	:	804-524-2435

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DENEEN J GREEN
Credential	:
Telephone Number	:	804-721-6341

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	06/20/2018

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