MEDICARE: LUCAS TAXI 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	344600000X	Taxi

General Provider Information

NPI Number	:	1740510411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCAS TAXI LLC

Provider Business Mailing Address
First Line	:	425 JESSAMINE AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3713
Country	:	US
Telephone Number	:	612-363-9132
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 JESSAMINE AVE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3713
Country	:	US
Telephone Number	:	612-363-9132
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. JAMES CHRISTOPHER PRENOSIL
Credential	:
Telephone Number	:	612-363-9132

Provider Enumeration Date	:	01/02/2010
Last Update Date	:	01/02/2010

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