Healthcare Provider Details

I. General information

NPI: 1376379990
Provider Name (Legal Business Name): AGILITY TRANSPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 VITRUVIAN WAY APT 617
ADDISON TX
75001-4488
US

IV. Provider business mailing address

3990 VITRUVIAN WAY APT 617
ADDISON TX
75001-4488
US

V. Phone/Fax

Practice location:
  • Phone: 443-525-8192
  • Fax:
Mailing address:
  • Phone: 443-525-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NDIDI VICTORIA NWANERI
Title or Position: OWNER
Credential:
Phone: 443-525-8192