MEDICARE: FAMILY TRANSPORTATION 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)
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1154071611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3501 MEARES DR APT 136
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1477
Country	:	US
Telephone Number	:	682-216-6198
Fax Number	:

Provider Business Practice Location Address
First Line	:	3531 PECOS WAY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7850
Country	:	US
Telephone Number	:	682-216-6198
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARNISE RICHARDS
Credential	:
Telephone Number	:	682-216-6198

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	06/03/2022

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Directions to “FAMILY TRANSPORTATION LLC ” Practice Location

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