MEDICARE: CLM EXPRESS 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	:	1992662795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLM EXPRESS LLC

Provider Business Mailing Address
First Line	:	1231 SUNSET DR STE 187
Second Line	:
City	:	GRENADA
State	:	MS
Zip	:	38901-4025
Country	:	US
Telephone Number	:	662-299-0913
Fax Number	:

Provider Business Practice Location Address
First Line	:	15711 HIGHWAY 51
Second Line	:
City	:	OAKLAND
State	:	MS
Zip	:	38948-2337
Country	:	US
Telephone Number	:	662-699-0913
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVONNE ROBERTS-TIDWELL
Credential	:	LPN
Telephone Number	:	662-699-0913

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “CLM EXPRESS LLC ” Practice Location

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