MEDICARE: A PLUS VANTAGE 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)	34390000X	TX

General Provider Information

NPI Number	:	1063969814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLUS VANTAGE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1005
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77410-1005
Country	:	US
Telephone Number	:	713-560-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	6314 TORRANCE ELMS CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-2064
Country	:	US
Telephone Number	:	713-560-0775
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. MARK ANTHONY SANCHEZ
Credential	:
Telephone Number	:	713-560-0775

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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