MEDICARE: THEO TRANSPORTATION

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	:	1114735768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEO TRANSPORTATION

Provider Business Mailing Address
First Line	:	311 N VISTA DR APT 905
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-5390
Country	:	US
Telephone Number	:	713-240-4655
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 N VISTA DR APT 905
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-5390
Country	:	US
Telephone Number	:	713-240-4655
Fax Number	:

Authorized Official
Title or Position	:	THE PRESIDENT
Name	:	MR. THEOPHILE KWEGUNTE
Credential	:
Telephone Number	:	713-240-4655

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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Directions to “THEO TRANSPORTATION ” Practice Location

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