MEDICARE: M & M TRANSPORT CARE

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	:	1770321036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & M TRANSPORT CARE

Provider Business Mailing Address
First Line	:	6631 CRESCENT LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-4653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6631 CRESCENT LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-4653
Country	:	US
Telephone Number	:	863-378-7445
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DELVIS MIRANDA
Credential	:
Telephone Number	:	863-378-7445

Provider Enumeration Date	:	07/19/2024
Last Update Date	:	07/19/2024

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