=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316575012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARBERS CONNECTION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2020
-----------------------------------------------------
Last Update Date | 03/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 MAYS DR
-----------------------------------------------------
City | WINNSBORO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71295-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-280-8815
-----------------------------------------------------
Fax | 469-433-0309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 248 VERNON DR
-----------------------------------------------------
City | FATE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75087-6740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-280-8815
-----------------------------------------------------
Fax | 469-433-0309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MARQUESA HOARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-280-8815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------