=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437866977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUT OF STEP INVESTMENTS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2022
-----------------------------------------------------
Last Update Date | 11/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 E BROAD ST STE 120
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-6597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-812-8812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8259 PROSPECT ST
-----------------------------------------------------
City | MOKELUMNE HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95245-9424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-812-8812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, OWNER
-----------------------------------------------------
Name | JEFFREY P JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-812-8812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------