MEDICARE: CAVALRY MEDICAL 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	341600000X	Ambulance	1561	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821091471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVALRY MEDICAL TRANSPORT,INC

Provider Business Mailing Address
First Line	:	1095 FAIRCHILD RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-4525
Country	:	US
Telephone Number	:	336-725-1031
Fax Number	:	336-725-9191

Provider Business Practice Location Address
First Line	:	1095 FAIRCHILD RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-4525
Country	:	US
Telephone Number	:	336-725-1031
Fax Number	:	336-725-9191

Authorized Official
Title or Position	:	VP OF BENEFITS AND RECEIVABLES
Name	:	AMANDA ROGERS
Credential	:	VP
Telephone Number	:	336-725-1031

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/03/2007

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