MEDICARE: MARIAN MEDICAL TRANSPORTATION 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	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1174394787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAN MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	9652 HATHMAN LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9538
Country	:	US
Telephone Number	:	682-583-8803
Fax Number	:

Provider Business Practice Location Address
First Line	:	9652 HATHMAN LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9538
Country	:	US
Telephone Number	:	682-583-8803
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIAN IBRAHIM
Credential	:
Telephone Number	:	682-583-8803

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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