MEDICARE: EXCEPTIONAL CARE 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	:	1952117061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL CARE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	9737 AMBERTON PKWY APT 2050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2045
Country	:	US
Telephone Number	:	702-409-4518
Fax Number	:

Provider Business Practice Location Address
First Line	:	3839 MCKINNEY AVE # 155-2150
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1413
Country	:	US
Telephone Number	:	702-409-4518
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ELSA MICHAEL TESFAGIORGIS
Credential	:
Telephone Number	:	702-409-4518

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	02/25/2025

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