MEDICARE: MR. KELVIN F WOODS

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)		TX

General Provider Information

NPI Number	:	1578110326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELVIN F WOODS

Provider Business Mailing Address
First Line	:	8115 WOODLYN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-1949
Country	:	US
Telephone Number	:	832-921-1936
Fax Number	:

Provider Business Practice Location Address
First Line	:	8115 WOODLYN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-1949
Country	:	US
Telephone Number	:	832-921-1936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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