MEDICARE: S AND T TRANSPORT

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	:	1417622358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S AND T TRANSPORT

Provider Business Mailing Address
First Line	:	6609 W FAIRVIEW AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-3934
Country	:	US
Telephone Number	:	414-841-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	6609 W FAIRVIEW AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-3934
Country	:	US
Telephone Number	:	414-841-8855
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY WRIGHT
Credential	:
Telephone Number	:	414-841-8855

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	08/12/2021

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Directions to “S AND T TRANSPORT ” Practice Location

Language	Start Address	Practice Location

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