=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346641990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | US DEJA VU SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2014
-----------------------------------------------------
Last Update Date | 09/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 POINCIANA PL
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75212-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-455-2355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2424 POINCIANA PL
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75212-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-455-2355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TINASHE MUNYARADZI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-455-2355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------