MEDICARE: DIVINE HANDS TRANSPORT 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	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1013546837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HANDS TRANSPORT LLC

Provider Business Mailing Address
First Line	:	104 INDUSTRIAL BLVD STE D
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3170
Country	:	US
Telephone Number	:	907-351-4814
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 INDUSTRIAL BLVD STE D
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3170
Country	:	US
Telephone Number	:	907-351-4814
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ISICHEI S ANENE
Credential	:
Telephone Number	:	907-351-4814

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	04/03/2020

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