MEDICARE: TIME AND PLACE 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)

General Provider Information

NPI Number	:	1477299337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIME AND PLACE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2523 N 14TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2516
Country	:	US
Telephone Number	:	414-915-3252
Fax Number	:

Provider Business Practice Location Address
First Line	:	2523 N 14TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-2516
Country	:	US
Telephone Number	:	414-915-3252
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTONIO GARNER
Credential	:
Telephone Number	:	414-915-3252

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	05/12/2022

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