MEDICARE: BOFREXTON 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	:	1295380210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOFREXTON LLC

Provider Business Mailing Address
First Line	:	2401 S COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1245
Country	:	US
Telephone Number	:	972-607-6340
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 S COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1245
Country	:	US
Telephone Number	:	972-607-6340
Fax Number	:

Authorized Official
Title or Position	:	C.E.O
Name	:	BABATOPE OMOJOKUN
Credential	:
Telephone Number	:	972-607-6340

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	09/20/2019

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Directions to “BOFREXTON LLC ” Practice Location

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