MEDICARE: TRANSPRO MEDICAL TRANSPORT

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	3416L0300X	Land Ambulance
2	341600000X	Ambulance

General Provider Information

NPI Number	:	1710419692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSPRO MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	1625 MOONLIGHT DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-5737
Country	:	US
Telephone Number	:	843-691-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	282 CENTER DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-5613
Country	:	US
Telephone Number	:	843-691-9123
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	NATALIE ANN CARUTHERS
Credential	:
Telephone Number	:	843-691-9123

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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