MEDICARE: ELNORA S SENIOR TRANSIT DENISE ANTIONETTE QUALLS SOLE MBR

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	:	1912845603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELNORA S SENIOR TRANSIT DENISE ANTIONETTE QUALLS SOLE MBR

Provider Business Mailing Address
First Line	:	207 LACKELL AVE UNIT 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78226-1617
Country	:	US
Telephone Number	:	210-793-2024
Fax Number	:	210-793-2024

Provider Business Practice Location Address
First Line	:	207 LACKELL AVE UNIT 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78226-1617
Country	:	US
Telephone Number	:	210-793-2024
Fax Number	:	210-793-2024

Authorized Official
Title or Position	:	OWNER
Name	:	DENISE ANTIONETTE QUALLS
Credential	:
Telephone Number	:	210-793-2024

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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