=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104306752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMA INTERPRIZE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2018
-----------------------------------------------------
Last Update Date | 08/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6780 GLORIA DR APT 30
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95831-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-628-3124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6780 GLORIA DR APT 30
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95831-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-283-1240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNNER
-----------------------------------------------------
Name | MR. ARLANDERS MYRON ATKINS
-----------------------------------------------------
Credential | OTHER
-----------------------------------------------------
Telephone | 916-283-1240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------