MEDICARE: T AND R MEDICAL 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	:	1275305666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T AND R MEDICAL TRANSPORTATION, LLC.

Provider Business Mailing Address
First Line	:	2428 E WILLAMETTE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4841
Country	:	US
Telephone Number	:	719-299-9078
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 E WILLAMETTE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4841
Country	:	US
Telephone Number	:	719-299-9078
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TONYA CISNEROS
Credential	:
Telephone Number	:	719-299-9078

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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