MEDICARE: PIC ME UP MEDICAL TRANSPORTATION SERVICES 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	:	1326756560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIC ME UP MEDICAL TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	1216 OKLAHOMA ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3624
Country	:	US
Telephone Number	:	337-419-8326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 OKLAHOMA ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3624
Country	:	US
Telephone Number	:	337-419-8326
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KENNETH LEE JACKSON
Credential	:
Telephone Number	:	337-419-8326

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	12/16/2022

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