MEDICARE: CREATION OF BEAUTY 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	:	1366931719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATION OF BEAUTY INC.

Provider Business Mailing Address
First Line	:	4031 CHENAULT ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-6907
Country	:	US
Telephone Number	:	817-353-0603
Fax Number	:	817-838-3737

Provider Business Practice Location Address
First Line	:	4031 CHENAULT ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-6907
Country	:	US
Telephone Number	:	817-353-0603
Fax Number	:	817-838-3737

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUTFI ALI LUTFI
Credential	:
Telephone Number	:	817-353-0603

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/01/2018

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