MEDICARE: EAGLE AFRICA TRADING AND DISTRIBUTION CORPORATION

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	:	1023955093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE AFRICA TRADING AND DISTRIBUTION CORPORATION

Provider Business Mailing Address
First Line	:	7120 N MILLS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-5285
Country	:	US
Telephone Number	:	704-241-2612
Fax Number	:	704-241-2612

Provider Business Practice Location Address
First Line	:	7120 N MILLS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-5285
Country	:	US
Telephone Number	:	704-241-2612
Fax Number	:	704-241-2612

Authorized Official
Title or Position	:	C.E.O
Name	:	TUNDE OLOYEDE SOBOWALE
Credential	:	MD
Telephone Number	:	704-241-2612

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/30/2026

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