MEDICARE: LEVEL 5 TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	342000000X	Transportation Network Company
2	343900000X	Non-emergency Medical Transport (VAN)
3	347E00000X	Transportation Broker
4	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1982387320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVEL 5 TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	10544 WALNUT ST STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-5358
Country	:	US
Telephone Number	:	901-283-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	10544 WALNUT ST STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-5358
Country	:	US
Telephone Number	:	901-283-6359
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	GEREMEW SHOMYE
Credential	:
Telephone Number	:	901-283-6357

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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