MEDICARE: ULTRACARE TRANSPORT 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	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1831901495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRACARE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	8181 MIDTOWN BLVD APT 7307
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8181 MIDTOWN BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4575
Country	:	US
Telephone Number	:	214-518-1130
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HIWOT GEBRIEL
Credential	:
Telephone Number	:	214-518-1130

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/29/2025

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