Provider Demographics
NPI:1285322941
Name:ULTRA MEDICAL DFW LLC
Entity type:Organization
Organization Name:ULTRA MEDICAL DFW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-707-2490
Mailing Address - Street 1:357 LOWERY OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1736
Mailing Address - Country:US
Mailing Address - Phone:614-707-2490
Mailing Address - Fax:
Practice Address - Street 1:357 LOWERY OAKS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-1736
Practice Address - Country:US
Practice Address - Phone:614-707-2490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)