MEDICARE: ELYON LOGISTICS AND TRANSPORT 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)

General Provider Information

NPI Number	:	1861154908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELYON LOGISTICS AND TRANSPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	15337 BARNABAS TRL
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-5566
Country	:	US
Telephone Number	:	571-484-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	18139 TRIANGLE SHOPPING PLZ STE 213
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22026-2582
Country	:	US
Telephone Number	:	571-484-6464
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KENNETH KWEKU BANSAH
Credential	:
Telephone Number	:	571-484-6464

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	07/19/2023

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