MEDICARE: ANGELA WOODS

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	:	1215567227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WOODS

Provider Business Mailing Address
First Line	:	PO BOX 60660
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-6660
Country	:	US
Telephone Number	:	817-455-5653
Fax Number	:

Provider Business Practice Location Address
First Line	:	2937 TIMBERLINE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-4735
Country	:	US
Telephone Number	:	817-455-5653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	01/17/2020

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