=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164209938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCAB NEMT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2023
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3823 SAGE RIDGE DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78247-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-346-7304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3823 SAGE RIDGE DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78247-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-346-7304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASHKAN AZEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-346-7096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------