MEDICARE: TANK GROUP 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)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1558229609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANK GROUP LLC

Provider Business Mailing Address
First Line	:	10527 KINGS RIVER DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-4191
Country	:	US
Telephone Number	:	313-638-0145
Fax Number	:

Provider Business Practice Location Address
First Line	:	10527 KINGS RIVER DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-4191
Country	:	US
Telephone Number	:	313-638-0145
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEYONE LEWIS DISMUKES
Credential	:
Telephone Number	:	313-638-0145

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/22/2026

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Directions to “TANK GROUP LLC ” Practice Location

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