MEDICARE: COVENANT TRANSPORTATION SERVICES, INC.

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	:	1295070589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT TRANSPORTATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	14906 WESTPARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-4943
Country	:	US
Telephone Number	:	281-302-5631
Fax Number	:	281-840-5595

Provider Business Practice Location Address
First Line	:	14906 WESTPARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-4943
Country	:	US
Telephone Number	:	281-302-5631
Fax Number	:	281-840-5595

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GREGORY HOLCOMB
Credential	:
Telephone Number	:	281-302-5631

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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