MEDICARE: CARAB LOGISTICS

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	:	1154601177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARAB LOGISTICS

Provider Business Mailing Address
First Line	:	3089 WINDCHASE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-3425
Country	:	US
Telephone Number	:	281-409-0129
Fax Number	:

Provider Business Practice Location Address
First Line	:	3089 WINDCHASE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-3425
Country	:	US
Telephone Number	:	281-409-0129
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. WYNNE NDULE
Credential	:
Telephone Number	:	281-409-0129

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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