MEDICARE: SPLENDID TRANSCARE 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	172A00000X	Driver		TX

General Provider Information

NPI Number	:	1164910774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPLENDID TRANSCARE LLC

Provider Business Mailing Address
First Line	:	1841 GREENFIELD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-1516
Country	:	US
Telephone Number	:	817-655-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 GREENFIELD AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-1516
Country	:	US
Telephone Number	:	817-655-5673
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RENE KONGA
Credential	:
Telephone Number	:	817-655-5673

Provider Enumeration Date	:	04/29/2018
Last Update Date	:	04/29/2018

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Directions to “SPLENDID TRANSCARE LLC ” Practice Location

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