=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497134258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INVALID NAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2015
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12400 W HWY 71 BLDG F
-----------------------------------------------------
City | BEE CAVE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-6517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-406-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12400 W HWY 71 BLDG F
-----------------------------------------------------
City | BEE CAVE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-6517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-406-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. INVALID ALAN INVALID
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 512-406-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146D00000X
-----------------------------------------------------
Taxonomy Name | Personal Emergency Response Attendant
-----------------------------------------------------
License Number | K7302
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------