=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205676616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS LANE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2024
-----------------------------------------------------
Last Update Date | 05/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 APPALOOSA CIR
-----------------------------------------------------
City | HOPKINTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01748-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-505-4642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 APPALOOSA CIR
-----------------------------------------------------
City | HOPKINTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01748-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-505-4642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MR. HAYK HARUTYUNYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 857-505-4642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------