=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124432646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3 VETSMEDICAL TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2014
-----------------------------------------------------
Last Update Date | 06/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 232 JUNIOR DR STE E
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-0990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-253-3578
-----------------------------------------------------
Fax | 314-475-5365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 232 JUNIOR DR STE E
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-0990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-253-3578
-----------------------------------------------------
Fax | 314-475-5365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELVIN TATE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-852-5619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------