=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053720300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERRANDS FOR ALL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2014
-----------------------------------------------------
Last Update Date | 08/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1258 MAIN ST
-----------------------------------------------------
City | GLADEWATER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75647-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-734-0374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9806
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75608-9806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MINDY KAMMERDIENER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-734-0374
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 800965171
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------