MEDICARE: WILL UP-LYFT 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)

General Provider Information

NPI Number	:	1356915615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILL UP-LYFT LLC

Provider Business Mailing Address
First Line	:	9900 WESTPARK DR STE 138
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5280
Country	:	US
Telephone Number	:	832-493-3271
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 WESTPARK DR STE 138
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5280
Country	:	US
Telephone Number	:	832-493-3271
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TIFFANY MONIQUE GIBBS
Credential	:	AM
Telephone Number	:	832-493-3271

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	09/19/2022

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Directions to “WILL UP-LYFT LLC ” Practice Location

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