MEDICARE: BOWMAN AND AVERY TRANSPORTATION

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)	215301	KY

General Provider Information

NPI Number	:	1104201888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWMAN AND AVERY TRANSPORTATION

Provider Business Mailing Address
First Line	:	2817 RIO RITA AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2412
Country	:	US
Telephone Number	:	502-749-3268
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 RIO RITA AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2412
Country	:	US
Telephone Number	:	502-749-3268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CIARA BOWMAN
Credential	:
Telephone Number	:	502-314-4250

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	07/23/2015

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