Healthcare Provider Details

I. General information

NPI: 1891214441
Provider Name (Legal Business Name): ELEGANT LOGISTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 07/21/2022
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 DATAPOINT DR STE 105
SAN ANTONIO TX
78229-2060
US

IV. Provider business mailing address

9650 DATAPOINT DR STE 105
SAN ANTONIO TX
78229-2060
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-0362
  • Fax: 210-375-9459
Mailing address:
  • Phone: 210-593-0362
  • Fax: 210-375-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number6337582
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. DADIRI YUSSUF JAMA
Title or Position: OWNER
Credential: DADIRI Y. JAMA
Phone: 210-593-0362