MEDICARE: WHITES EXECUTIVE SERVICES 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)		TX

General Provider Information

NPI Number	:	1770932329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITES EXECUTIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	2351 W NORTHWEST HWY
Second Line	:	SUITE 3357
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-600-4081
Fax Number	:	866-224-2441

Provider Business Practice Location Address
First Line	:	2351 W NORTHWEST HWY
Second Line	:	SUITE 3357
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-600-4081
Fax Number	:	866-224-2441

Authorized Official
Title or Position	:	CEO
Name	:	MRS. AMY WHITE
Credential	:
Telephone Number	:	214-600-4081

Provider Enumeration Date	:	06/05/2016
Last Update Date	:	06/05/2016

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