Provider Demographics
NPI:1326405986
Name:WODELA MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:WODELA MEDICAL TRANSPORT LLC
Other - Org Name:WODELA TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOSSIVI
Authorized Official - Middle Name:WODY
Authorized Official - Last Name:EDJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-477-2691
Mailing Address - Street 1:1906 STIELER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-1175
Mailing Address - Country:US
Mailing Address - Phone:214-477-2691
Mailing Address - Fax:
Practice Address - Street 1:7676 HILLMONT ST
Practice Address - Street 2:SUITE 240W
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6400
Practice Address - Country:US
Practice Address - Phone:832-680-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)