MEDICARE: GREENVILLE TRANSPORTATION SERVICES 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	:	1427911080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	1521 MANCHESTER DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-6650
Country	:	US
Telephone Number	:	252-565-6809
Fax Number	:	252-565-6809

Provider Business Practice Location Address
First Line	:	1521 MANCHESTER DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-6650
Country	:	US
Telephone Number	:	252-565-6809
Fax Number	:	252-565-6809

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. DEREK JUAN GRAVES JR
Credential	:
Telephone Number	:	252-565-6809

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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