Provider Demographics
NPI:1730601733
Name:ATX DESTINY TRANSPORTAION LLC
Entity type:Organization
Organization Name:ATX DESTINY TRANSPORTAION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIGESTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBEREZIGIABEHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-363-2093
Mailing Address - Street 1:4209 VEILED FALLS DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5536
Mailing Address - Country:US
Mailing Address - Phone:512-363-2093
Mailing Address - Fax:
Practice Address - Street 1:4209 VEILED FALLS DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5536
Practice Address - Country:US
Practice Address - Phone:512-363-2093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)