MEDICARE: SPIRIT OF LIFE TRANSPORTATION SERVICES, 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)

General Provider Information

NPI Number	:	1952885881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRIT OF LIFE TRANSPORTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 480883
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-5307
Country	:	US
Telephone Number	:	980-237-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	4313 DAVID COX RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8962
Country	:	US
Telephone Number	:	980-237-7836
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DEBRA FINKLEA BELLAMY
Credential	:	NURSE'S AIDE
Telephone Number	:	704-649-5048

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	03/01/2021

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