MEDICARE: TRI COUNTY CALL A RIDE 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	344600000X	Taxi		MI

General Provider Information

NPI Number	:	1891026456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI COUNTY CALL A RIDE LLC

Provider Business Mailing Address
First Line	:	5405 21 MILE RD
Second Line	:	PO BOX 176
City	:	SAND LAKE
State	:	MI
Zip	:	49343-9476
Country	:	US
Telephone Number	:	616-889-4646
Fax Number	:	616-819-6673

Provider Business Practice Location Address
First Line	:	5405 21 MILE RD
Second Line	:	176
City	:	SAND LAKE
State	:	MI
Zip	:	49343-9476
Country	:	US
Telephone Number	:	616-889-4646
Fax Number	:	616-819-6673

Authorized Official
Title or Position	:	DIRECTOR OF TRANSPORTATION SERVICES
Name	:	MR. TIMOTHY JAMES FUNK
Credential	:
Telephone Number	:	616-889-4646

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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Directions to “TRI COUNTY CALL A RIDE LLC ” Practice Location

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