MEDICARE: WILLBRUN PREMIUM SHUTTLE SERVICE 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	:	1326906561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLBRUN PREMIUM SHUTTLE SERVICE LLC

Provider Business Mailing Address
First Line	:	417 N MAIN ST
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 N MAIN ST
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2305
Country	:	US
Telephone Number	:	864-636-7065
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RAVEN WILLIAMS-BRUNSON
Credential	:
Telephone Number	:	864-553-3779

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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