MEDICARE: CBR 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)	976378559	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346688967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CBR TRANSPORT LLC

Provider Business Mailing Address
First Line	:	1250 SHARP HILL RD
Second Line	:
City	:	ARKPORT
State	:	NY
Zip	:	14807-9502
Country	:	US
Telephone Number	:	585-728-9019
Fax Number	:	607-968-8046

Provider Business Practice Location Address
First Line	:	1250 SHARP HILL RD
Second Line	:
City	:	ARKPORT
State	:	NY
Zip	:	14807-9502
Country	:	US
Telephone Number	:	585-728-9019
Fax Number	:	607-968-8046

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL SOLE PROPRIETOR
Name	:	REBECCA S KILSDONK
Credential	:
Telephone Number	:	585-728-9019

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	09/03/2019

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