MEDICARE: AT YOUR SERVICE RELIABLE TRANSPORT LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver
2	343900000X	Non-emergency Medical Transport (VAN)
3	343900000X	Non-emergency Medical Transport (VAN)	LA

General Provider Information

NPI Number	:	1770097941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT YOUR SERVICE RELIABLE TRANSPORT LLC.

Provider Business Mailing Address
First Line	:	3113 MOORE STATION RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 MOORE STATION RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5043
Country	:	US
Telephone Number	:	318-423-4561
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINS.
Name	:	MRS. ANNA WELLS
Credential	:
Telephone Number	:	318-423-4561

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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