=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003635715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AK ELITE TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2024
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 PARKSIDE DR
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-298-7543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 811 PARKSIDE DR
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-298-7543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | ANDREA ERSKINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-298-7543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------