MEDICARE: MBM TRANSPORTATION 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	:	1932850773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBM TRANSPORTATION LLC.

Provider Business Mailing Address
First Line	:	23169 MICHIGAN AVE # 2717
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-0001
Country	:	US
Telephone Number	:	313-415-9755
Fax Number	:	313-731-6994

Provider Business Practice Location Address
First Line	:	23169 MICHIGAN AVE # 2717
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-0001
Country	:	US
Telephone Number	:	313-415-9755
Fax Number	:	313-731-6994

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED BERRO
Credential	:
Telephone Number	:	313-415-9755

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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