MEDICARE: BLUE VULCAN USA, 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	:	1154003549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE VULCAN USA, LLC

Provider Business Mailing Address
First Line	:	5955 ALPHA RD STE 1396
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1121
Country	:	US
Telephone Number	:	214-444-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	5955 ALPHA RD STE 1396
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1121
Country	:	US
Telephone Number	:	214-444-9197
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	GEARLDEAN LEGGETT
Credential	:
Telephone Number	:	214-444-9197

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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Directions to “BLUE VULCAN USA, LLC ” Practice Location

Language	Start Address	Practice Location

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