MEDICARE: HOLMES IN TRANSIT 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	:	1922772540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLMES IN TRANSIT LLC

Provider Business Mailing Address
First Line	:	4911 W GOOD HOPE RD STE 112
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-4840
Country	:	US
Telephone Number	:	262-777-4294
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 W GOOD HOPE RD STE 112
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-4840
Country	:	US
Telephone Number	:	262-777-4294
Fax Number	:	262-599-6929

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DEREK HOLMES
Credential	:
Telephone Number	:	262-777-4294

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	08/06/2021

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