MEDICARE: MEDXPRESS TRANSPORTATION SERVICES

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)	A210016198	TX

General Provider Information

NPI Number	:	1619279494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDXPRESS TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	3101 WOODLARK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1014
Country	:	US
Telephone Number	:	817-423-8629
Fax Number	:	817-704-4354

Provider Business Practice Location Address
First Line	:	3101 WOODLARK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1014
Country	:	US
Telephone Number	:	817-423-8629
Fax Number	:	817-704-4354

Authorized Official
Title or Position	:	OWNER
Name	:	CHERRY RANDLE SCOTT
Credential	:
Telephone Number	:	817-423-8629

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	11/30/2010

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