MEDICARE: SERENITY ANGLE TRANSPORTATION 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)
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1841030251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY ANGLE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	9900 WESTPARK DR STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5286
Country	:	US
Telephone Number	:	832-817-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 WESTPARK DR STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5286
Country	:	US
Telephone Number	:	832-817-2262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED MOHAMED ALI
Credential	:
Telephone Number	:	832-817-2262

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	07/01/2024

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