=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225313729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUCCESS TRANSPORTATION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2011
-----------------------------------------------------
Last Update Date | 10/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4678 SAN LUCAS WAY
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95135-2343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-449-0357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4678 SAN LUCAS WAY
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95135-2343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-449-0357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. PRINCE-STANLEY AMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 14084490357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 9377284929
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------