MEDICARE: HEAVEN SENT MEDICAL SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center	103502	CA

General Provider Information

NPI Number	:	1043499858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVEN SENT MEDICAL SERVICE INC

Provider Business Mailing Address
First Line	:	2050 RUSSETT WAY
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-2112
Country	:	US
Telephone Number	:	775-443-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 JENSEN AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2288
Country	:	US
Telephone Number	:	775-443-8282
Fax Number	:

Authorized Official
Title or Position	:	CARDIOVASCULAR SONOGRAPHER
Name	:	MR. JACOB TAIWO AKINDELE
Credential	:	ARDCS
Telephone Number	:	775-443-8282

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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