MEDICARE: E.L.L D TRANSPORT LC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1103X	Military Ambulatory Procedure Visits Operational (Transportable) Clinic/Center
2	261QA0005X	Ambulatory Family Planning Facility
3	261QA0006X	Ambulatory Fertility Facility
4	261QM1102X	Military Outpatient Operational (Transportable) Component Clinic/Center
5	341600000X	Ambulance
6	342000000X	Transportation Network Company
7	343800000X	Secured Medical Transport (VAN)
8	347B00000X	Bus
9	347C00000X	Private Vehicle
10	347E00000X	Transportation Broker
11	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1265111074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E.L.L D TRANSPORT LC

Provider Business Mailing Address
First Line	:	9535 FOREST LN STE 119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6120
Country	:	US
Telephone Number	:	469-518-3009
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 FOREST LN STE 119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6120
Country	:	US
Telephone Number	:	469-518-3009
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. LEVERN DANIELS JR.
Credential	:
Telephone Number	:	469-518-3009

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	10/16/2023

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