MEDICARE: ICONIC GLOBAL CARE 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)

General Provider Information

NPI Number	:	1811373210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICONIC GLOBAL CARE LLC

Provider Business Mailing Address
First Line	:	7915 BURNING OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3370
Country	:	US
Telephone Number	:	832-228-1193
Fax Number	:

Provider Business Practice Location Address
First Line	:	7915 BURNING OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3370
Country	:	US
Telephone Number	:	832-228-1193
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANCIS OBINZU
Credential	:
Telephone Number	:	832-228-1193

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	08/07/2015

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