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General NPI Number Information
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NPI Number | 1194067157
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Entity Type | Organization
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Legal Business Name | BACU CASPIAN CORP
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 4801 GROVE ST 1W
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City | SKOKIE
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State | IL
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Zip | 60077-1725
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Country | US
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Telephone | 773-290-4406
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Fax | 847-983-4551
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Provider Business Mailing Address
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Address Line | 4801 GROVE ST 1W
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City | SKOKIE
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State | IL
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Zip | 60077-1725
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Country | US
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Telephone | 773-290-4406
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Fax | 847-983-4551
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Authorized Official
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Title or Position | NON-EMERGENCY MEDICAL TRANSPORT
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Name | MR. ALI AZIMOV
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Credential |
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Telephone | 773-290-4406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | IL
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