MEDICARE: FORT WORTH NON-EMERGENCY TRANSPORTATION

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	343800000X	Secured Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1396416905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WORTH NON-EMERGENCY TRANSPORTATION

Provider Business Mailing Address
First Line	:	1965 REVOLUTIONARY WAY APT 3305
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1965 REVOLUTIONARY WAY APT 3305
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1439
Country	:	US
Telephone Number	:	214-888-8888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HASSAN HASSAN
Credential	:
Telephone Number	:	214-888-6734

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	06/20/2024

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