MEDICARE: GP LIFT RIDES 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	:	1083388466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GP LIFT RIDES LLC

Provider Business Mailing Address
First Line	:	7577 N TEUTONIA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2041
Country	:	US
Telephone Number	:	262-748-2596
Fax Number	:

Provider Business Practice Location Address
First Line	:	7577 N TEUTONIA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2041
Country	:	US
Telephone Number	:	262-748-2596
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NICOSIA KING
Credential	:
Telephone Number	:	262-748-2596

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	08/09/2021

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Directions to “GP LIFT RIDES LLC ” Practice Location

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