MEDICARE: PEACE MEDICAL TRANSPORTATION SERVICES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871995944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE MEDICAL TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	3445 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2220
Country	:	US
Telephone Number	:	614-674-6607
Fax Number	:	614-456-7562

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	AHMADOU KANE
Credential	:
Telephone Number	:	614-596-7025

Provider Enumeration Date	:	09/20/2014
Last Update Date	:	09/20/2014

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