MEDICARE: GM 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)	801376712	MS

General Provider Information

NPI Number	:	1386120319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GM TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	5101 ELDER ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-3101
Country	:	US
Telephone Number	:	228-990-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 ELDER ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-3101
Country	:	US
Telephone Number	:	228-990-1771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GREGORY ANDRE MURRAY JR.
Credential	:
Telephone Number	:	228-990-1771

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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