MEDICARE: POE'S TRANSIT

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	343800000X	Secured Medical Transport (VAN)	10393PT	IL
2	343900000X	Non-emergency Medical Transport (VAN)	10348PT	IL
3	343900000X	Non-emergency Medical Transport (VAN)	10347PT	IL

General Provider Information

NPI Number	:	1740414986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POE'S TRANSIT

Provider Business Mailing Address
First Line	:	40 LAKEVIEW ST
Second Line	:
City	:	WOLF LAKE
State	:	IL
Zip	:	62998-1000
Country	:	US
Telephone Number	:	573-429-7513
Fax Number	:	618-833-8910

Provider Business Practice Location Address
First Line	:	40 LAKEVIEW ST
Second Line	:
City	:	WOLF LAKE
State	:	IL
Zip	:	62998-1000
Country	:	US
Telephone Number	:	573-429-7513
Fax Number	:	618-833-8910

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PHILLIP WAYNE POE
Credential	:
Telephone Number	:	618-833-2211

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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Directions to “POE'S TRANSIT ” Practice Location

Language	Start Address	Practice Location

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