MEDICARE: TERRENCE BROOKS

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	:	1770359408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRENCE BROOKS

Provider Business Mailing Address
First Line	:	18043 BELLINGRATH LAKES AVE
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-4752
Country	:	US
Telephone Number	:	225-229-3817
Fax Number	:

Provider Business Practice Location Address
First Line	:	18043 BELLINGRATH LAKES AVE
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-4752
Country	:	US
Telephone Number	:	225-229-3817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ TERRENCE BROOKS ” Practice Location

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