=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477947372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE-STOP MEDEX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2015
-----------------------------------------------------
Last Update Date | 03/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37600 CENTRAL CT SUITE 280
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-3455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-500-4487
-----------------------------------------------------
Fax | 510-868-0257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 211
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-0211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-500-4487
-----------------------------------------------------
Fax | 510-868-0257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | EMEM ITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-500-4487
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 201108810130
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------