MEDICARE: EZ MED TRANSPORT, INC

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	:	1780015222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ MED TRANSPORT, INC

Provider Business Mailing Address
First Line	:	5632 N ORIOLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3307
Country	:	US
Telephone Number	:	312-286-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	5632 N ORIOLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3307
Country	:	US
Telephone Number	:	312-286-4143
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SUBHASH BHATT
Credential	:
Telephone Number	:	312-286-4143

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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