MEDICARE: SAFEWAY PASSAGE

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)	1296078	VA

General Provider Information

NPI Number	:	1891180527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY PASSAGE

Provider Business Mailing Address
First Line	:	3702 MALBON WAY
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-7800
Country	:	US
Telephone Number	:	804-833-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	8012 MIDLOTHIAN TPKE
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5232
Country	:	US
Telephone Number	:	804-833-1383
Fax Number	:

Authorized Official
Title or Position	:	GP
Name	:	JANELL LINARES
Credential	:
Telephone Number	:	804-930-6172

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	03/31/2015

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Directions to “SAFEWAY PASSAGE ” Practice Location

Language	Start Address	Practice Location

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