=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215376942
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AJAJ TRANSPORTAION SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2013
-----------------------------------------------------
Last Update Date | 06/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8439 W CATHERINE AVE 719
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60656-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-934-3994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8439 W CATHERINE AVE 719
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60656-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-934-3994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TRANSPORTATION
-----------------------------------------------------
Name | MR. FAISAL AWADALLA LBRAHIM I
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-934-3994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 68880874
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------