MEDICARE: ANGEL WINGS MEDCARE TRANSPORT, 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	:	1720897523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL WINGS MEDCARE TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	8402 FOXTAIL LOOP
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-3240
Country	:	US
Telephone Number	:	850-454-9241
Fax Number	:

Provider Business Practice Location Address
First Line	:	8402 FOXTAIL LOOP
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-3240
Country	:	US
Telephone Number	:	850-454-9241
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MARIA D JOHNSON
Credential	:
Telephone Number	:	850-454-9241

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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