MEDICARE: GOOD SAMARITAN COMFORT TRANSPORTATION

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	:	1750570933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN COMFORT TRANSPORTATION

Provider Business Mailing Address
First Line	:	25900 GREENFIELD RD STE 250
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1297
Country	:	US
Telephone Number	:	248-742-9324
Fax Number	:

Provider Business Practice Location Address
First Line	:	25900 GREENFIELD RD STE 250
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1297
Country	:	US
Telephone Number	:	248-742-9324
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. PHILLIP ADEWALE BAKARE
Credential	:
Telephone Number	:	313-646-5931

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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