MEDICARE: CSW MEDICAL 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)
2	344600000X	Taxi

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	:	1649891466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSW MEDICAL TRANSPORT, LLC.

Provider Business Mailing Address
First Line	:	5815 NEW HARTFORD ST
Second Line	:
City	:	WOLCOTT
State	:	NY
Zip	:	14590-1136
Country	:	US
Telephone Number	:	315-956-5113
Fax Number	:	866-394-0428

Provider Business Practice Location Address
First Line	:	5815 NEW HARTFORD ST
Second Line	:
City	:	WOLCOTT
State	:	NY
Zip	:	14590-1136
Country	:	US
Telephone Number	:	315-956-5113
Fax Number	:	866-394-0428

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DOROTHY MARIE KYLE
Credential	:
Telephone Number	:	315-956-5113

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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