MEDICARE: DYNASTY TRANSPORT 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)

General Provider Information

NPI Number	:	1063289569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNASTY TRANSPORT GROUP LLC.

Provider Business Mailing Address
First Line	:	4212 S RIO GRANDE AVE APT 204
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1240
Country	:	US
Telephone Number	:	689-255-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 S RIO GRANDE AVE APT 204
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1240
Country	:	US
Telephone Number	:	689-255-1113
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER / OWNER
Name	:	DEMETRIUS DANTE BILLINGS
Credential	:
Telephone Number	:	689-255-1113

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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