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NPI Code Detail

MEDICARE: COMMUNITY TRANSPORTATION ADVANTAGE LLC

MEDICARE: COMMUNITY TRANSPORTATION ADVANTAGE 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
1343900000XNon-emergency Medical Transport (VAN)

General Provider Information

NPI Number : 1679353148
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY TRANSPORTATION ADVANTAGE LLC
Provider Business Mailing Address
First Line : 3040 N 56TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-1529
Country : US
Telephone Number : 262-424-1020
Fax Number :
Provider Business Practice Location Address
First Line : 3040 N 56TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-1529
Country : US
Telephone Number : 262-424-1020
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BRYANT ALEXANDER DORSEY
Credential :
Telephone Number : 262-424-1020
Provider Enumeration Date : 10/03/2023
Last Update Date : 10/03/2023

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Directions to “COMMUNITY TRANSPORTATION ADVANTAGE LLC ” Practice Location

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