MEDICARE: YADH-EL MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1053135533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YADH-EL MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	12650 CROSSROADS PARK DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3371
Country	:	US
Telephone Number	:	281-509-4705
Fax Number	:

Provider Business Practice Location Address
First Line	:	12650 CROSSROADS PARK DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3371
Country	:	US
Telephone Number	:	281-509-4705
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BLESSING OGU
Credential	:
Telephone Number	:	281-509-4705

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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