MEDICARE: TERRANCE BROOKS

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)	SK659889	OH

General Provider Information

NPI Number	:	1184307480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE BROOKS

Provider Business Mailing Address
First Line	:	14708 ASPINWALL AVE STE 3
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-2313
Country	:	US
Telephone Number	:	440-771-3117
Fax Number	:

Provider Business Practice Location Address
First Line	:	14708 ASPINWALL AVE STE 3
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-2313
Country	:	US
Telephone Number	:	440-771-3117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “ TERRANCE BROOKS ” Practice Location

Language	Start Address	Practice Location

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