Healthcare Provider Details

I. General information

NPI: 1801300868
Provider Name (Legal Business Name): A24 TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 HORNBEAM DR
DALLAS TX
75243-2607
US

IV. Provider business mailing address

12611 HORNBEAM DR
DALLAS TX
75243-2607
US

V. Phone/Fax

Practice location:
  • Phone: 469-642-6517
  • Fax:
Mailing address:
  • Phone: 469-642-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. MOSHREG TAHA MUSTAFA VI
Title or Position: MD
Credential: OWNER
Phone: 469-642-6517