MEDICARE: SUNCOAST NON- EMERGENCY TRANSPORTATION CORP.

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	:	1811424443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST NON- EMERGENCY TRANSPORTATION CORP.

Provider Business Mailing Address
First Line	:	435 S RIDGEWOOD AVE # 203
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4927
Country	:	US
Telephone Number	:	386-256-5507
Fax Number	:	386-256-5509

Provider Business Practice Location Address
First Line	:	435 S RIDGEWOOD AVE # 203
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4927
Country	:	US
Telephone Number	:	386-256-5507
Fax Number	:	386-256-5509

Authorized Official
Title or Position	:	VP
Name	:	MR. WALTER HILL
Credential	:
Telephone Number	:	386-214-7042

Provider Enumeration Date	:	05/14/2017
Last Update Date	:	05/14/2017

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