MEDICARE: O & M TRANSPORTATION

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)	05397692	TX

General Provider Information

NPI Number	:	1154867703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O & M TRANSPORTATION

Provider Business Mailing Address
First Line	:	1309 HOLLY GLEN DR .
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232
Country	:	US
Telephone Number	:	214-563-4954
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 HOLLY GLEN DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1109
Country	:	US
Telephone Number	:	214-563-4954
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ORLANDO AMEN
Credential	:
Telephone Number	:	214-563-4954

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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