Provider Demographics
NPI:1598141038
Name:OMNITRANSIT LLC
Entity Type:Organization
Organization Name:OMNITRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTABARUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-247-1824
Mailing Address - Street 1:14625 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2767
Mailing Address - Country:US
Mailing Address - Phone:469-247-1824
Mailing Address - Fax:
Practice Address - Street 1:1403 BIRDS FORT TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1244
Practice Address - Country:US
Practice Address - Phone:469-247-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QM0850X
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)