MEDICARE: FRIENDLY AND FAMILY 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	:	1073219291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDLY AND FAMILY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1953 N 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1806
Country	:	US
Telephone Number	:	414-628-8498
Fax Number	:

Provider Business Practice Location Address
First Line	:	1953 N 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1806
Country	:	US
Telephone Number	:	414-628-8498
Fax Number	:

Authorized Official
Title or Position	:	DRIVER
Name	:	LAKEISHA BROOMS
Credential	:
Telephone Number	:	414-628-8498

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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