MEDICARE: FOBBS AMIABLE CARE TRANSPORT ETC 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	347C00000X	Private Vehicle
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1861199051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOBBS AMIABLE CARE TRANSPORT ETC LLC

Provider Business Mailing Address
First Line	:	1528 BRIAR GLENN RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8103
Country	:	US
Telephone Number	:	252-557-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 BRIAR GLENN RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8103
Country	:	US
Telephone Number	:	252-557-5505
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DOMAINE JARVEZ FOBBS SR.
Credential	:
Telephone Number	:	252-557-5505

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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