MEDICARE: PENNSY LINE SERVICE 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	:	1285334086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSY LINE SERVICE LLC

Provider Business Mailing Address
First Line	:	2203 MANSARD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-4411
Country	:	US
Telephone Number	:	832-417-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 MANSARD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-4411
Country	:	US
Telephone Number	:	832-417-9333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BAHARELDIN SALIH
Credential	:
Telephone Number	:	215-696-2010

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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Directions to “PENNSY LINE SERVICE LLC ” Practice Location

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