MEDICARE: HEALTH LANE TRANSPORT

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	:	1851013890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH LANE TRANSPORT

Provider Business Mailing Address
First Line	:	6026 JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-2235
Country	:	US
Telephone Number	:	314-941-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6026 JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-2235
Country	:	US
Telephone Number	:	314-941-9999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHAVONDA MITCHELL
Credential	:
Telephone Number	:	314-941-9999

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/15/2022

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