MEDICARE: TRAVIS &FAMILY TRANSPORT 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	:	1003633421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVIS &FAMILY TRANSPORT LLC

Provider Business Mailing Address
First Line	:	9219 RAINBOW CREEK WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4814
Country	:	US
Telephone Number	:	916-289-0659
Fax Number	:

Provider Business Practice Location Address
First Line	:	9219 RAINBOW CREEK WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4814
Country	:	US
Telephone Number	:	916-289-0659
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLENE TRAVIS
Credential	:
Telephone Number	:	916-289-0659

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	09/25/2024

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