MEDICARE: VIOLET TRANSPORTATIONS

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1376019299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIOLET TRANSPORTATIONS

Provider Business Mailing Address
First Line	:	5901 E STASSNEY LN APT 1604
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-4652
Country	:	US
Telephone Number	:	512-872-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 E STASSNEY LN APT 1604
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-4652
Country	:	US
Telephone Number	:	512-872-9512
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MS. IDA K MBOWE
Credential	:	CNA
Telephone Number	:	512-872-9512

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	10/18/2018

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Directions to “VIOLET TRANSPORTATIONS ” Practice Location

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