MEDICARE: GOODMAN TRANSPORT SERVICES, 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	332BC3200X	Customized Equipment (DME)
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1891093852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODMAN TRANSPORT SERVICES, INC.

Provider Business Mailing Address
First Line	:	5004 KEMPS FARM PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5540
Country	:	US
Telephone Number	:	757-222-1890
Fax Number	:	757-233-8432

Provider Business Practice Location Address
First Line	:	5004 KEMPS FARM PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5540
Country	:	US
Telephone Number	:	757-222-1890
Fax Number	:	757-233-8432

Authorized Official
Title or Position	:	PRESIDENT/ DIRECTOR
Name	:	MR. EPHRAIM THOMAS GOODMAN JR.
Credential	:
Telephone Number	:	757-237-8275

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	12/15/2011

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Directions to “GOODMAN TRANSPORT SERVICES, INC. ” Practice Location

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