MEDICARE: MR. & MRS. 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	:	1205390937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR. & MRS. TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	2791 BURRI TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-6337
Country	:	US
Telephone Number	:	321-243-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	2791 BURRI TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-6337
Country	:	US
Telephone Number	:	321-243-9181
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DRIVER
Name	:	CHRISTINE A JACKSON
Credential	:
Telephone Number	:	941-445-3021

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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