MEDICARE: LIBERTY TRANSPORT COMPANY,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)

General Provider Information

NPI Number	:	1912688870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY TRANSPORT COMPANY,LLC

Provider Business Mailing Address
First Line	:	3545 AIRWAY DR STE 107
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-1847
Country	:	US
Telephone Number	:	775-453-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 AIRWAY DR STE 107
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-1847
Country	:	US
Telephone Number	:	775-453-1111
Fax Number	:

Authorized Official
Title or Position	:	CEO/MANAGING MEMBER
Name	:	BRIAN SCOTT GILBERTSON
Credential	:
Telephone Number	:	775-453-1111

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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