MEDICARE: TIME 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	343900000X	Non-emergency Medical Transport (VAN)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1821875352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIME TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3959 MIRA LINDA PT APT 1521
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6909
Country	:	US
Telephone Number	:	303-550-1629
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 MIRA LINDA PT APT 1521
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-6909
Country	:	US
Telephone Number	:	303-550-1629
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WONDU A KALEWOLD
Credential	:
Telephone Number	:	303-550-1629

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	09/08/2023

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