Healthcare Provider Details

I. General information

NPI: 1881308724
Provider Name (Legal Business Name): FMAT LIMITED COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 ZORA DR
TEMPLE TX
76504-8691
US

IV. Provider business mailing address

1022 ZORA DR UNIT A
TEMPLE TX
76504-8691
US

V. Phone/Fax

Practice location:
  • Phone: 646-465-1633
  • Fax:
Mailing address:
  • Phone: 646-465-1633
  • Fax:

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 Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MOPILEOLA TOMI ADEWUMI
Title or Position: OWNER
Credential: DO
Phone: 646-465-1633