=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073744645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLES CHOICE MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2009
-----------------------------------------------------
Last Update Date | 07/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1938 JIM CASEBOLT WAY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95835-1749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 188-838-2611
-----------------------------------------------------
Fax | 188-838-2611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1938 JIM CASEBOLT WAY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95835-1749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 188-838-2611
-----------------------------------------------------
Fax | 188-838-2611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER/TREASURER
-----------------------------------------------------
Name | MR. ROBERT ERIC LEWIS JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 18883826119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------