MEDICARE: LAKESHORE MEDICAL TRANSPORT

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	:	1609751056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	12808 W AIRPORT BLVD STE 325C
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-6227
Country	:	US
Telephone Number	:	713-364-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	12808 W AIRPORT BLVD STE 325C
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-6227
Country	:	US
Telephone Number	:	713-364-6848
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BUBACARR SAMATEH
Credential	:
Telephone Number	:	503-267-8905

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

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Directions to “LAKESHORE MEDICAL TRANSPORT ” Practice Location

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