MEDICARE: LEE'S AMBULATE AND 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	251C00000X	Developmentally Disabled Services Day Training Agency
2	261QA0600X	Adult Day Care Clinic/Center
3	291U00000X	Clinical Medical Laboratory
4	292200000X	Dental Laboratory
5	293D00000X	Physiological Laboratory
6	305R00000X	Preferred Provider Organization
7	311ZA0620X	Adult Care Home Facility
8	320700000X	Physical Disabilities Residential Treatment Facility	754348166	NY
9	343800000X	Secured Medical Transport (VAN)
10	343900000X	Non-emergency Medical Transport (VAN)
11	347C00000X	Private Vehicle
12	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
13	347E00000X	Transportation Broker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295123214	OTHER	NY	NPI 1295123214

General Provider Information

NPI Number	:	1740714666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE'S AMBULATE AND TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 7451
Second Line	:	BOX 7451
City	:	FREEPORT
State	:	NY
Zip	:	11520-0758
Country	:	US
Telephone Number	:	516-476-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 WEST MERRICK ROAD BX7451
Second Line	:	BOX 7451
City	:	FREEPORT
State	:	NY
Zip	:	11520-0758
Country	:	US
Telephone Number	:	516-476-4029
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DRIVER
Name	:	MS. VERONICA D BUCKLES
Credential	:
Telephone Number	:	516-476-4029

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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