MEDICARE: SHAVON'S TRANSPORT AND LOGISTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	347E00000X	Transportation Broker
3	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1750018537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAVON'S TRANSPORT AND LOGISTICS LLC

Provider Business Mailing Address
First Line	:	411 N SAM HOUSTON PKWY E STE 365
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3543
Country	:	US
Telephone Number	:	346-479-6256
Fax Number	:	214-494-8379

Provider Business Practice Location Address
First Line	:	411 N SAM HOUSTON PKWY E STE 365
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3543
Country	:	US
Telephone Number	:	346-479-6256
Fax Number	:	214-494-8379

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RENITA GAMBLE
Credential	:	CMT-BC
Telephone Number	:	346-479-6256

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/24/2022

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