MEDICARE: BROTHERS IN CARE MEDICAL 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)

General Provider Information

NPI Number	:	1255076881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROTHERS IN CARE MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	1310 NEW HOUSE ROAD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150
Country	:	US
Telephone Number	:	407-755-8753
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 NEW HOUSE ROAD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150
Country	:	US
Telephone Number	:	407-755-8753
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DONOVAN LA'BRYANT GIDNEY
Credential	:
Telephone Number	:	407-755-8753

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	04/28/2022

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