MEDICARE: COMFORT TRAVEL NON-EMERGENCY 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)

General Provider Information

NPI Number	:	1033776943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT TRAVEL NON-EMERGENCY TRANSPORT LLC

Provider Business Mailing Address
First Line	:	4164 HEATON TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-2618
Country	:	US
Telephone Number	:	941-303-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	4164 HEATON TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-2618
Country	:	US
Telephone Number	:	941-303-7669
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. CLIVE WINSTON DOCKERY
Credential	:
Telephone Number	:	941-303-7669

Provider Enumeration Date	:	05/26/2019
Last Update Date	:	05/26/2019

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