MEDICARE: ARCHWAY 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	:	1740846583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHWAY LLC

Provider Business Mailing Address
First Line	:	7643 GATE PKWY FL 810
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2893
Country	:	US
Telephone Number	:	469-386-5476
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 OFFICE PLZ STE A
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-2844
Country	:	US
Telephone Number	:	469-386-5476
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	NWACHUKWU J EKEOCHA
Credential	:
Telephone Number	:	469-386-5476

Provider Enumeration Date	:	05/17/2019
Last Update Date	:	05/17/2019

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Directions to “ARCHWAY LLC ” Practice Location

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