=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245620525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL TRANSPORTATION SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2015
-----------------------------------------------------
Last Update Date | 01/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 663 OLD CAMBRIDGE RD
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76365-5642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-551-3699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 147 663 OLD CAMBRIDGE RD.
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76365-0147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-551-3699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | MRS. CHRISTINA NEWBERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-551-3699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | 801042346
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 801042346
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------