MEDICARE: WILSON GLOBAL MEDICAL 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	:	1720545692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON GLOBAL MEDICAL TRANSPORTATION,LLC

Provider Business Mailing Address
First Line	:	126 E COLLEGE AVE
Second Line	:
City	:	HOLLY SPRINGS
State	:	MS
Zip	:	38635-3022
Country	:	US
Telephone Number	:	662-333-1075
Fax Number	:	662-333-1111

Provider Business Practice Location Address
First Line	:	126 E COLLEGE AVE
Second Line	:
City	:	HOLLY SPRINGS
State	:	MS
Zip	:	38635-3022
Country	:	US
Telephone Number	:	662-333-1075
Fax Number	:	662-333-1111

Authorized Official
Title or Position	:	OWNER
Name	:	LATOYA CALHOUN
Credential	:
Telephone Number	:	662-333-1075

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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