MEDICARE: TRAVELIN MERCIES 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	:	1871018184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVELIN MERCIES LLC

Provider Business Mailing Address
First Line	:	205 GLENWOOD ST SW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 GLENWOOD ST SW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3507
Country	:	US
Telephone Number	:	330-904-0018
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BEVERLY NORMAN
Credential	:
Telephone Number	:	330-904-0018

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	08/08/2017

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