MEDICARE: BRAND KETCHMORE 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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1689452450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAND KETCHMORE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2019 N ARMISTEAD AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-3402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2019 N ARMISTEAD AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-3402
Country	:	US
Telephone Number	:	757-927-9845
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TROY KETCHMORE
Credential	:
Telephone Number	:	757-620-9325

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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