MEDICARE: ULTRA MEDICAL DFW 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	:	1285322941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA MEDICAL DFW LLC

Provider Business Mailing Address
First Line	:	357 LOWERY OAKS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-1736
Country	:	US
Telephone Number	:	614-707-2490
Fax Number	:

Provider Business Practice Location Address
First Line	:	357 LOWERY OAKS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-1736
Country	:	US
Telephone Number	:	614-707-2490
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MUSE HUSSEIN
Credential	:
Telephone Number	:	614-707-2490

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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