MEDICARE: ADVANCED QUALITY TRANSPORTATION SERVICE, 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	343900000X	Non-emergency Medical Transport (VAN)	9502238	FL

General Provider Information

NPI Number	:	1902057557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED QUALITY TRANSPORTATION SERVICE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 4211
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33918-4211
Country	:	US
Telephone Number	:	239-656-0911
Fax Number	:	239-656-0190

Provider Business Practice Location Address
First Line	:	4008 WHOLESALE CT
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-4277
Country	:	US
Telephone Number	:	239-656-0911
Fax Number	:	239-656-0190

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL LITTEN
Credential	:
Telephone Number	:	239-656-0911

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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