MEDICARE: QUANTUM LEAP 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	:	1346902970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUM LEAP TRANSPORT LLC

Provider Business Mailing Address
First Line	:	PO BOX 11215
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-0215
Country	:	US
Telephone Number	:	414-372-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 W HIGHLAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1025
Country	:	US
Telephone Number	:	414-372-6425
Fax Number	:	844-599-2630

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY MCBEATH
Credential	:
Telephone Number	:	414-372-6425

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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