MEDICARE: HASSAN HASSAN SR.

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	:	1619580313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASSAN HASSAN SR.

Provider Business Mailing Address
First Line	:	4504 CATHEDRAL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-8159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4504 CATHEDRAL DR APT 1404
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-8704
Country	:	US
Telephone Number	:	214-779-2265
Fax Number	:

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	03/28/2026

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