MEDICARE: A1 COMFORT RIDE 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	:	1790153245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1 COMFORT RIDE LLC

Provider Business Mailing Address
First Line	:	2310 E WERGES AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-1063
Country	:	US
Telephone Number	:	317-760-8290
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 S KEYSTONE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3610
Country	:	US
Telephone Number	:	317-760-8290
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN ROBERTS
Credential	:
Telephone Number	:	317-760-8290

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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