Provider Demographics
NPI:1891214441
Name:ELEGANT LOGISTICS
Entity Type:Organization
Organization Name:ELEGANT LOGISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DADIRI
Authorized Official - Middle Name:YUSSUF
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DADIRI Y JAMA
Authorized Official - Phone:210-593-0362
Mailing Address - Street 1:9650 DATAPOINT DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2060
Mailing Address - Country:US
Mailing Address - Phone:210-593-0362
Mailing Address - Fax:210-375-9459
Practice Address - Street 1:9650 DATAPOINT DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2060
Practice Address - Country:US
Practice Address - Phone:210-593-0362
Practice Address - Fax:210-375-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343800000X, 343900000X, 344600000X, 347B00000X, 347C00000X, 347E00000X
TX6337582343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid