MEDICARE: PUGET EXPRESS 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)	603103025	WA

General Provider Information

NPI Number	:	1982042115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUGET EXPRESS LLC

Provider Business Mailing Address
First Line	:	3800 S 176TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98188-4152
Country	:	US
Telephone Number	:	206-687-8804
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 S 176TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98188-4152
Country	:	US
Telephone Number	:	206-687-8804
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISAIAH FIKRE
Credential	:
Telephone Number	:	206-466-5331

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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