MEDICARE: HIGHLAND TRANSPORT DALLAS 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)	23871702	TX

General Provider Information

NPI Number	:	1356783963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND TRANSPORT DALLAS LLC

Provider Business Mailing Address
First Line	:	2730 N STEMMONS FWY
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75207-2279
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 N STEMMONS FWY
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75207-2279
Country	:	US
Telephone Number	:	214-954-7894
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	EYOB YETBAREK
Credential	:
Telephone Number	:	214-954-7894

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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