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
1	343900000X	Non-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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