MEDICARE: DICKERSONS 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)

General Provider Information

NPI Number	:	1326647496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKERSONS TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	234 BAKER ST STE 5
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93305-5856
Country	:	US
Telephone Number	:	661-384-4835
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 BAKER ST STE 5
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93305-5856
Country	:	US
Telephone Number	:	661-384-4835
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN D DICKERSON II
Credential	:
Telephone Number	:	661-384-4835

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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