MEDICARE: MARANATHA TRANSPORTATION SERVICES

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	:	1891668232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARANATHA TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	572 POCAHONTAS DR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	572 POCAHONTAS DR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-3259
Country	:	US
Telephone Number	:	850-774-8934
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN THOMAS
Credential	:
Telephone Number	:	850-774-8934

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	09/23/2025

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