MEDICARE: G-WAGON NEMT 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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1942167226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G-WAGON NEMT LLC

Provider Business Mailing Address
First Line	:	10342 GLIMMER
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-0800
Country	:	US
Telephone Number	:	726-251-2793
Fax Number	:

Provider Business Practice Location Address
First Line	:	10342 GLIMMER
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-0800
Country	:	US
Telephone Number	:	726-251-2793
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS C GONZALEZ
Credential	:
Telephone Number	:	726-251-2793

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	04/21/2026

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