MEDICARE: PASSENGER PRO 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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1457199507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSENGER PRO TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6515 ROCKLAKE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2870
Country	:	US
Telephone Number	:	843-472-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	6515 ROCKLAKE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2870
Country	:	US
Telephone Number	:	843-472-7233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LARRY BACCUS JR.
Credential	:
Telephone Number	:	843-472-7233

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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