MEDICARE: 757 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	:	1386113579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	757 TRANSPORT LLC

Provider Business Mailing Address
First Line	:	3848 MEADOWBROOK CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-2106
Country	:	US
Telephone Number	:	757-935-7759
Fax Number	:	757-463-3500

Provider Business Practice Location Address
First Line	:	3848 MEADOWBROOK CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-2106
Country	:	US
Telephone Number	:	757-935-7759
Fax Number	:	757-463-3500

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BENJAMIN KEVIN FRANKLIN
Credential	:
Telephone Number	:	757-935-7759

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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