=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073075602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOKEN MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2019
-----------------------------------------------------
Last Update Date | 04/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6677 W MAY APPLE DR
-----------------------------------------------------
City | MCCORDSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46055-4447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-426-1797
-----------------------------------------------------
Fax | 317-613-7730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6677 W MAY APPLE DR
-----------------------------------------------------
City | MCCORDSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46055-4447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-426-1797
-----------------------------------------------------
Fax | 317-613-7730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | TOCHUKWU C ILOABUCHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 904-874-6826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------