MEDICARE: PURPLE HEARTS TRANSPORTATION 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)
2	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1831800242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE HEARTS TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5725 BOCA RATON BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2423
Country	:	US
Telephone Number	:	682-291-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5725 BOCA RATON BLVD # 57
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2423
Country	:	US
Telephone Number	:	682-291-1707
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/ OWNER
Name	:	CORA LEE TAYLOR
Credential	:
Telephone Number	:	682-291-1707

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	02/01/2023

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