MEDICARE: SAFE TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)	F0112E	MI

General Provider Information

NPI Number	:	1922542364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6370 VILLAGE PARK DR APT 104
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2156
Country	:	US
Telephone Number	:	313-617-5228
Fax Number	:

Provider Business Practice Location Address
First Line	:	6370 VILLAGE PARK DR APT 104
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2156
Country	:	US
Telephone Number	:	313-617-5228
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES D BRANCH
Credential	:
Telephone Number	:	313-617-5228

Provider Enumeration Date	:	12/04/2016
Last Update Date	:	12/04/2016

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