MEDICARE: SMOOTH TRIP 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	:	1598401200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMOOTH TRIP TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	3160 HIGHWAY 21 STE 103
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8888
Country	:	US
Telephone Number	:	803-833-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 OZARK CT
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9809
Country	:	US
Telephone Number	:	704-678-6474
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBBIN SEXTON
Credential	:
Telephone Number	:	803-833-8050

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	05/06/2022

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